An overview on the elephants of acute, adult neuro-rehabilitation in the private sector. Corina Botha Unit Manager: Therapy Pasteur Hospital - PDF

Please download to get full document.

View again

of 57
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information Report
Category:

Games & Puzzles

Published:

Views: 2 | Pages: 57

Extension: PDF | Download: 0

Share
Related documents
Description
An overview on the elephants of acute, adult neuro-rehabilitation in the private sector Corina Botha Unit Manager: Therapy Pasteur Hospital Focus of Presentation mplexity of disability itations in national
Transcript
An overview on the elephants of acute, adult neuro-rehabilitation in the private sector Corina Botha Unit Manager: Therapy Pasteur Hospital Focus of Presentation mplexity of disability itations in national and rnational systems uro rehabilitation in private lthcare erational elephants Neuro-rehabilitation nitially the rehabilitation of CVA and TBI mbrella term for the management of isabling conditions isabling condition: Any condition that ause a restriction or lack of ability to erform an activity in the manner or within he range considered normal for a person of he same age, culture and education. ICF Model Health Condition Disorder or disease Body ons & Structures Activities Participation vironmental factors Personal factors . A primary objective of any health care intervention is the enhancement of quality of life. Indeed, for those individuals diagnosed with a chronic condition where cure is not attainable and (treatment) may be prolonged, quality of life is likely to be the essential outcome Berzon, 2000 Health Related Quality of Life (HRQOL) atients appraisals of their own level of functioning and satisfaction with it, compared to what they perceive to be the ideal Case Study 1: Mrs. Venter Years old ys with 78 year old sband teo-arthritis left hip vere pain tal hip -replacement spitalized for 7 days t-patient therapy Mr. Thabane 36 year old architect Very successful, talented Happily married to a teacher 8 year old daughter Family in MVA Wife passed away Mr. Thabane C4 incomplete tetraplegia- ASIA B Disability Sudden onset / unexpected outcome Irreversible consequences Cure prolonged/ unattainable Permanent life-style change Prone to co-morbidities and codisabilities Effects all areas of life Activity & participation limitations Questions quality and purpose of life Neuro-rehab population troke (CVA) omplex medical onditions raumatic brain injuries pinal cord injuries mputations ulti-trauma egenerative disorders ther Internal External COMBINATION High Acuity: st patients have complex combinations of otor, sensory, cognitive and functional mpairments. Results from database indicate: nificant communication problems-30% mpaired mobility 88% onfused, disorientated: 42% usher syndrome/ Apraxia-9% ncontinent-80% eglect -23% Complications: inful shoulders essure Sores fections (UTI, Pulmonary, etc.) uro-pathic & musculo skeletal pain scle shortening & contractures lnutrition sphagia & Aspiration pression stural deformities actures due to falling Independence vs. Risk Functional dependence RISK Efficient risk management & training techniques Functional outcome ecreased function Incidents How well are we managing disabling conditions Prevention Is Still Better Than Cure!! Macro: olitical stability ocio-economical stability nd resource anagement egislation- traffic control, egislation ealthcare systems and nfrastructures ducation systems thics and morality Micro: Risk management: Unmodifiable risks Lifestyle choices Medication control Avoid dangerous environments and activities Choice, commitment and taking responsibility for our actions & satisfaction with life South African Context n you believe it e airport has st my trunk again! revention Cure??? Risk Management Maintenance Monitor & Control Etiology Classify Risk Profiling Limit mortalities disability & co-morbidity Risk Management Functional Solutions ehabilitation Education & lifestyle change EHABILITATION PROCESS munity re-integration & long term care te, functional out-patient rehabilitation te, functional in-patient Rehabilitation ute medical management & early intervention Prevention: Macro & Micro General Hospital Incident GP Trauma ICU/ HC Ward ut-pt Follow-up/integr Home Rehab Model 1:National Incident Specialised Unit ollow-up Out-pt Home/ integration Model 2:International Other hern pe Lesotho Bloemfontein Kroonstad Welkom Bethlehem Aliwal North Kimberley Rehabilitation- Universally costly ecialised medical procedures & special vestigations gh burden of care -morbidity and risk management ecial diets and supplements ams of experts-special training & experience ecialised equipment fe, accessible environments quires additional customer care and quality itiatives olonged length of stay Acute, outcomes based inpatient rehabilitation ecently introduced in the SA rivate Health Care System ublic sector, Mining industry nd Military Hospitals mall, foreign service in the igger healthcare sector ompliments various services.g. orthopaedic, neurourgery, internal medicine, etc. Entabeni -Durban Eugene Marais-Pretoria Little Company of Mary- Pretoria Riferfielddge-JHB New Kensington-JHB Clinic Management Funders Referring Sources Nursing Staff P General Ward T Funders Referring Sources FEE FOR SERVICE Corporate Health care setting Functional outcomes Rehabilitation Process: Assessment Goal setting Integrated Admissions Report b admissions Consultant Funding Clinical Management Weekly reports Q vironment Service Team meeting FUNDER: uality care at an affordable price orporate support tandards olicies usiness values Admission Case management Financial Management Communicate with funder Clinical management Enhance functional independence Management of recourses TQM REHABILITATION POPULATION: TRENDS LIFE PASTEUR MED SCI ORTHO TBI CVA TBI CVA SCI MED ORTO Clinical consideration 1: Differences between various diagnostic groups: Etiology Risk profiles Clinical pictures and functional profiles Co-morbidities Recovery process Prognosis Multiple Sclerosis BI CVA Left Hemiplegia SCI C5 Complete Asia A Occupational Therapy Physiotherapy uillian Barre TBI mur # SCI T12 Complete Asia A with AKA TBI CVA Left Hemiplegia Speech Therapy Bilateral lower limb amputations Neuropsychologist Cardio- Vascular SCI C5 incomplete CVA Left Hemiplegia CVA Left Hemiplegia Medical social worker Clinical consideration 2: Variability within diagnostic groups: Severity of condition Clinical and functional profile Recovery process and prognosis Risk profiles Severe: /FAM levels 1-2 or/ socioitive/ combined) plex binations of lems h risk to develop orbidities and uires specialist vention with rds to risk agement k management unctional ponents Moderate: FIM/FAM levels 3-5 (Motor/ sociocognitive/ combined) Risk needs to be consideredspecialist intervention not a necessity Focus on functional retraining ACUITY Mild: FIM/FAM levels 5-7 (Motor/ sociocognitive/ combined) Risk management problematic due to decreased higher cognitive and executive skills Basic functional skills are in place but patient still requires structure supervision and guidance Acuities 14% 68% 14% 2 % 2 % Complete Dependence: Severe High risks High burden of care. FIM/FAM- 1 to 3 Modified Dependence: Moderate burden of care: Similar to most people Independence: Lower burden of care FUNCTIONAL OUTCOMES IN CVA- IRON-H. LAUBCHER INTERNATIONAL NATIONAL-Private sector Clinical consideration 3: imilarities in functional and risk profiles across diagnostic borders Patients have combinations of problems Similarities in the approaches required for different diagnostic groups Variety of factors contribute to rehabilitation outcome Similarities between bio-mechanical and neurological deficits: e stability & postural trol ximal stability bility vs. mobility endent on sensory ems ance & control with rds to gravitational es Prone to Co-morbidities Alignment Upper and lower limb control Endurance FUNCTIONAL IMPAIRMENTS Lifestyle adaptations urrent rehabilitation trends egration of Bio-mechanical & neurological ues/ problems scipline driven versus issue driven egration of models construction and revival of previous models itations in outcomes measures- Performance icators for task components gnificant impact of the sensory systems habilitation is essentially about restoring ferent components of life CASESTUDY 2: Mrs. AC year old Widow from a farm the Freestate sband- farmer & GPssed away about 2 years o o grown-up children mily from a higher socioonomic income group ves horses-accomplished er. althy, active individual prior accident 16 th of December injured in a MVA near her farm CT brain: multiple heamorrhagic contusions in left fronto-parietal, left parietal & left temporal areas. Pelvis fracture, rib fractures & compression fracture L1. 4 weeks in ICU- 4 weeks in HCU. Transferred for rehab 4 months later. Questions How do you explain this patient s functional challenges? Do you think other professionals would agree with you? What would you do to facilitate a client-centred, integrated approach with regards to the management of this patient/ hallenges: Clinical reasoning How can we try and fix life Outcome? e was Who he is now BILITATION INVOLVES THE COMPLEXITY OF LIFE- All Spheres linicians: nt clinical ounds, areas of terminology, tual orks, etc. nt levels of dge, skills, nce, etc. External factors: International trends Legislation Recourses HPCSA Funding and service delivery model model FUNDER/ REFERRING CLINICIAN: Quality care at an affordable price ntrusted pt in our care Families arious back grounds Limited pathology knowledge Emotional link cus: Restore quality of life Permanent staff Nursing/Medical: Impairment driven Pressure sores Risk for falling Waterflow Medical risk Therapy staff: Function driven Activity analyses FIM/FAM Agency staff /Locums /students: Pleasure / Reward/ Acceptance/Freedom acter: influenced tion of d with skills n & learning le in the aturity k from nt and ages selfe alance/ sis tion vs. ent ation vs. CHARACTER Temperament Drive Motivation Passion Spirituality and/or morality Perceptions & experiences Attitudes, Believes, Choices Desires Self regulation Strategies Balance Content Level of Maturity and Creative Internal stressors/rewards External stressors/rew Eternality Current context Health/Life Death/disease Purpose Self actualisation Highest level of creative participation Body organ structures & functions Occupation Level of independence icipation text /environment Basic capacities & functions Integrated functions Complex functions Developed and learned capacities Executive functions Self regulation and energy Control Personal independence Recreation Vocational Family & community involvement Learning Risk and recourses Spatio temporal Structures Control - Self: Capacity to learn Voluntary vs. Subconscious Interdependency of structures Development vs. Deterioration Homeostasis: Internal vs., external Sustaining energy Control Tasks/activities: Capacity to apply learning and perform Capacity to choose a lifestyle that fits talents, passion & environmental requirements Links person with environment Self regulatory skills and use of energy recourses Control Physical context Recourse management, Praxis, Manual Reward/ Acceptance/Freedom Basic capacities & functions ACTER rament ive ation sion uality /or ality tions & iences udes, eves, ices pose elf isation st level eative ipation ires elf lation egies nce Eternality Current context Mental Health Problems Trauma, Disease, Developmental problems, Deterioration Loss of meaningful occupation, changes in routine, limited opportunity, inefficient self regulation Accessabity, poor resources manages, financial losses, damages Loss of meaningful Integrated functions Complex functions Developed and learned capacities Executive functions Self regulation and energy Control Personal independence Recreation Vocational Family & community involvement Learning Risk and recourses Spatio temporal Structures Recourse management, Praxis, Manual ehabilitation Conceptual Framework Theoretical Framework Standard Terminology Assessment Tools Enhanced Clinical Reasoning Interpretation guidelines/ Clinical Reasoning Treatment Tools Outcomes measures Integrated goal setting Clinical Pathways Comprehensive documentation pproach: Try to consider all the above as well as our context (Complex) Considerations: Focus of framework stic groups nt ns s different ches ion only a stic e le es for onditionof ial factors ch: line Functional Focus on functional profiles irrespective of condition Functional outcomes measures mostly focused on burden of care as apposed to performance on functional components Function dependent on basic skills Acuities Focus on burden of care and severity of condition Focus on functional components as well as physical and psychological profile Requires a variety of outcomes measures ICF Body organ structure Function Capacity to participate Consider positive and negative aspects Time consuming, not always usable in our setting ical Assessment k assessment ateral and other information ue complexity of problems arge plan: ted outcome unity rses y support ing vement Current profile & dynamics of condition on functioning Feedback process: Integrated team Medical aids Referring clinicians Families/patient Etc. Adapt goals according to progress and new information Functional Outcomes & Treatment goals Treatment intervention Outcomes measures & progress OT Business vs. Care Profitability: cupancy st control siness efficiency owth source management uman, time, financial,.) aptability within ever anging context Health care: Client centred approach Quality products at an affordable price Quality service delivery Total quality experience Lifetime partnerships Adaptability Efficiency and outcomes measurement Values drives the culture CSF eliver ncompromising uality to all customers rowth agenda evelop our people and ecognize contributions lexible marketing trategy- distinctive ompetitive advantage ransformation-in ocio-political nvironment Values Passion for people Performance pride Personal care Lifetime partnerships Quality: Ethics Energy Excellence Empowerment Empathy SO-Quality Management Systems ontinual improvement of the quality management system Management Responsibility tomers Customers Resource Management Measurement, analyses and improvement Satisfaction uirements Product realisation Product her elephants in a rehab unit ccupancy - high vs. low ustomer service- difficult patients/families orporate image. Value of a good name elp carry the trauma & emotional burden of patients ompensate for abnormal behaviour rey areas in professional team pectations from patient, family, medical aid, referring inicians. Expected functional outcome nancial constrains nmotivated patients or patients/families with lack of sight in their therapy goals ther elephants in a rehab unit perational standards (quality & quantity of ervice delivery) atient s with risk profiles- health & safety igh standards of performance expected ittle time for debriefing & rest nappropriate & disruptive patients ersonal conflict, perceptions & negative xperiences nadequate communication Burnout syndrome G R O T h A C H IE V E M E N T THANK YOU
Recommended
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks