Occupational Therapy ICU part 2 Roundtable 2014

Occupational Therapy in the ICU

3 Problems to target: prolonged bedrest and ventilation, sensory deprivation

and stress, and cognitive impairment

OT TreatmentsOT Treatments

Upper Extremity Exercise, positioning, splinting

Early participation in functional activities and ADLs

Cognitive stimulation

Use of technology for alternative treatment interventions

Participation in ICU diaries

ICU DiariesICU Diaries

Purpose: to fill memory gaps and provide an understanding of what happened in a chronological narrative account.

Connects facts with autobiographical memory (or lack of) to make sense of a time that may have been dominated by delirium or confusion.

A way to communicate the experience with others.

Communication Communication technologytechnology

Encouraged use of and iPad and/or Eye Gaze System for communication while on vent or trach

Use of iPads for fine motor coordination tasks and UB strengthening

Use of iPad and/or Eye Gaze System for cognition activity

Program GoalsProgram Goals

Designated OT’s in the ICU

Prioritizing ICU patients

Advocate Team Approach to patient care

Participate in Research Log Book by documenting highest level of ADL performance (sitting or higher)

Additional Additional ResourcesResources

Family involvement menu, Mobility guidelines, Engagement tool

Family Involvement Family Involvement MenuMenu

Welcome: Welcome to Mayo Clinic hospital ICU

Purpose: We believe that you know the person we are serving better than we do. We would like to invite you to participate in your loved ones care.

Contract: We would like to participate in the care of this person with the following tasks. We are receptive to instruction.

tasks: incentive spyrometry, bath care, eating care, exercise, etc

Mobility toolsMobility toolsMobility Board / Quality Board Board / Quality Board

Guidelines/fact sheets

levels of consciousness (assessment, activity, therapy)

Is my patient ready to start mobility activity today? (neuro, respiratory, cardiovascular screens)

Progressive Mobility tolerence screen

Progressive Mobility decision tree for PT /OT consults

Function toolsFunction tools

standardize as much as possible

grip test

6 minute walk test

Quality of Life measure

EngagementEngagement

Operant Conditioning: learning that occurs through rewards and punishments of behavior (ie: positive and negative reinforcement)

Motivational Interviewing: using patient goals or values to shape care

Resist righting, understand patient motivation, reflective listening, empowerment

as apposed to using goals centered on external factors

Engagement toolsEngagement tools

Done in collaboration with whole team

Starter: Hand-off communication tools for therapist to therapist and for therapist to / from nurse

Advanced model: Bundle system-wide an interdisciplinary approach to communicating function so there is seamless progress when patients move unit to unit

SafetySafety

Study concluded out of 5300 PT sessions with 50% sitting or higher activity level, there were only 34 potential safety occurrences (89% of them were changes in vital signs). There were no major events such as catheters or trachs removed or MI’s. There were 2 assisted falls and 1 unassisted fall. Only 8 events that needed minimal intervention.

Potential area of study as we proceed with our culture of mobility.

Thank YouCarmen Cononie, Kristien Daron, Rebekah Davis, Hali Cole