Thursday, April 23, 2009

The importance of quick assessment

I have been finding that over the last wee while i have been slow to assess patients function particularly if the team are thinking they may not may not benefit from rehab.
For example today i was referred a patient this morning and the physio had decided that this patient was not particulary appropraite for rehab. I went and talked to the patient and her daughter and gathered their perception of how the patient was going to function when she returned home. It was obvious that the daughter was VERY anxious and i should have been more proactive in assessing the function of the patient to determine whether or not she would be appropraite for rehab. By the time i got to assess the patients function i figured out that there my percpetion of how the patient was managing was ALOT different to the percpetion of the daughter. Also im not sure if the patient and her daughter realised the aim of rehab as i reflect now i think the reasons they thought rehab would be good was not for function it was for sorting out medical stuff...
The daughter was quite adament that her mother needed rehab and i could see that the patient had deconditioned in terms of activity tolerance and confidence. However after discussing this with my supervisor i realised that these were not "good" enough reasons to have a stint in rehab.
What i have learnt about myself today is alot!
1) i need to be more proactive in assessing function before even mentioning rehab (even though in this situation the daughter had already had her eyes set on it)
2) more importantly - i need to develop skill in reasoning with patient and clearly communicating with them how they are functioning, what they could or couldnt get out of rehab and i guess standing up for myself more - giving my opinion and recommendations and then letting the team decide

It was hard today because i felt like it was down to me to make the decision when it shouldnt have been like that at all! Im only part of the team!

Oh well i will learn! But i guess i need to get clear in my head the rationale for someone to be appropratie for rehab and start going though the criteria when considering if someone is appropriate

So here is a wee plan that i will talk about with my supervisor

Is this patient independent with ADL’S ?
Are they having trouble with mobility, transfers, showering, dressing or toileting?
Do they have room for improvement?
Has there function altered compared to pre-admission?
Do they have insight into their abilities?
Are they able to learn new information/techniques?
Do they live alone?
Do they have good supports?
Is pain the main issue?
Is confidence the main issue?

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