Standardized Rle Prfile Occupatinal Therapist (OT) - Acute Medical Inpatient Service Purpse f this Dcument: A key deliverable f the Mdel f Care Initiative in Nva Sctia is the establishment f prvince-wide standardized rles t enable mre cnsistent wrk practices at full scpe f practice. The purpse f this dcument is t describe the intent f a standardized and cnsistent rle fr an Occupatinal Therapist (OT). The fcus is n practice within an acute care medical/surgical inpatient setting. The fllwing table identifies thse rle functins f the OT that are expected t have a renewed emphasis and be ptimized in the new Cllabrative Care Mdel, as well as tasks that can be safely transferred ut f the rle, either t anther rle within the prfessin r t ther members f the care team. It is expected that all OTs in Nva Sctia will practice accrding t the standards and related dcuments defined by their cllege and n attempt was made t replicate these expectatins in this draft dcument. Renewed Emphasis Optimized Transferred Cmprehensive, client centered assessments and interventins Identificatin f Occupatinal Perfrmance Issues Interdisciplinary care prvisin Fcus n client centered care, rather than prvider driven care Engagement f the client and his / her supprt system in the care prcess Fcus n preventin, t prevent future admissin and issues Occupatinal Therapy services at a systems level and with a fcus n ppulatin health Prgram develpment, such as chrnic disease management, and creating linkages with inpatient, cmmunity and primary health care services Act as a Cmmunicatr, t prmte f the prfessin f Occupatinal Therapy, and the cncepts f ccupatinal perfrmance, ccupatinal functining and ccupatinal engagement Act as a Change Agent t align plicy and ther systems elements t client centered needs Act as a Prfessinal thrugh teaching, mentring and rientatin, and educatin fr prfessinal develpment Act as a cnsultant t facilitate discharge planning and transitins acrss the health care cntinuum, ensuring the patients needs are met in apprpriate setting Research Exhibit expertise in enabling ccupatins ( e.g. assessment, educatin, and interventin) in the mst functinally relevant envirnment (e.g., cmmunity, hme, schl ) fr the client Act as a Cllabratr t facilitate cllabratin acrss the cntinuum f care, including imprved cmmunicatin between cmmunity, tertiary hspitals, reginal hspitals, etc. Develpment and implementatin f interdisciplinary, cllabrative care plans, and discharge plans. Facilitating established clinical grups and/r educatin prgrams Supervisin f Occupatinal therapy assistants and aides in the running f established plan f care, that are within the abilities / skills / scpes f an assistant r aide Fcus ccupatinal perfrmance / ccupatinal functining and ccupatinal engagement; rather than n individual perfrmance cmpnents Act as a Practice Manager thrugh the develpment and implementatin f care plans and crdinatin f specific ppulatins Act as a Schlarly Practitiner thrugh reflective practice with an emphasis n best practice Clerical duties: typing, cpying, filing, appintment bking, faxing, etc. Data entry / wrklad statistic input Equipment maintenance and inventry Researching and surcing f equipment, btaining qutes n equipment Organizing, gathering, and preparing clinical supplies, equipment, assessment kits, etc. Rutine functinal mbility activities Prtering f clients Typing qutes, faxing and fllwing up n equipment / supply qutes 1
Standardized Rle Prfile Occupatinal Therapist OT Rle Summary: The Occupatinal Therapist (OT) is ne f the cllabratrs in the Cllabrative Care Mdel, participating in the prvisin f hlistic, cmprehensive care t meet the needs f clients. As a member f the team, the OT participates in the verall plan f care with the client by prviding ccupatinal therapy services. Occupatinal Therapy Services are indicated when engagement in the ccupatins f everyday living becmes a challenge r engagement is at risk f becming a challenge. The visin and gals f Occupatinal Therapy, include envirnmental and system level actins with r fr individuals and grups, such as: Enabling cmmunity re-engagement Adapting and designing prgrams and the envirnment fr safety and interdependence Crdinating cmmunity cnnectins fr cmmunity / scial inclusin Advcating with clients and the cmmunity t develp resurce supprts Educating clients, families, etc. t manage chrnic disease and disability Enabling ptimal participatin in hme, wrk, cmmunity, and sciety Enabling participatin in all aspects f every day life Occupatinal Therapy assessment invlves the identificatin f Occupatinal Perfrmance Issues, challenges related t ccupatinal engagement and the identificatin f strengths and barriers related t the Occupatins, Envirnment, and Persn. Assessment methds include, but are nt limited t: Functinal Assessment and task analysis f self care, leisure and prductivity ccupatins; and standardized assessments. The OT cntributes t the client s plan f care based n the analysis f assessment findings, chsen theretical appraches, clinical best practices, critical thinking, and cllabratin with the client. Occupatinal Therapy Interventins aim t facilitate safe, functinal, engagement in self care, prductivity and leisure ccupatins; and minimize barriers that impede engagement in ccupatins. Interventin may include n ne r mre f the fllwing: remediatin, adaptatin, cmpensatin, preventin, health prmtin, r educatin. Interventins typically target the persn, ccupatin, and envirnment cllectively as these elements are interrelated. Interventins may take place in the medical surgical unit, r in functinal envirnments (e.g., hme, schl, cmmunity lcatins, and wrk) relevant t the client. In cllabratin with the client, his/her supprt system and the health care team, the OT mnitrs client s respnse t interventin and mdifies/grades treatments, care plan, and discharge plans, as indicated. 2
Standardized Rle Prfile Occupatinal Therapist OT Occupatinal Therapist s Key Respnsibilities: I. COMPETENT PRACTICE (see Appendix 1 Supprting Dcuments) Assessment: 1. Screens and priritizes referrals t Occupatinal Therapy t determine the individual s need fr ccupatin therapy services 2. Perfrms initial and nging assessment. The initial assessment aims t understand the client s pre-admissin status as cmpared t current status. The initial assessment gathers baseline infrmatin with the client, t facilitate re-evaluatin f the client s status at later pints in the care prcess. 3. Assessment invlves identificatin f Occupatinal Perfrmance Issues (OPIs); identificatin f challenges related t ccupatinal engagement, and identificatin f strengths and barriers related t the Persn, Occupatins, and Envirnment, and their interactin with ne anther. Specifically, the assessment may include, but is nt limited t assessment f: Occupatins Envirnment Self Care ccupatins fr lking after the self. (e.g., persnal care, persnal respnsibilities, functinal mbility, and rganizatin f persnal space and time) Prductivity ccupatins that make a scial r ecnmic cntributin (e.g., play in infancy/childhd, schl wrk, emplyment, hmemaking, parenting, and cmmunity vlunteering Leisure ccupatins fr enjyment (e.g., scializing, creative expressins, utdr activities, games, and sprts) Physical (e.g., physical and built surrundings) Scial (e.g., values, attitudes, and beliefs) Cultural (e.g., ethnic, racial, ceremnial, and rutine practice, based n the eths and value system f particular grups) Institutinal (plitical, ecnmical, legal, and legislative cmpnents) Examples f OPIs include, but are nt limited t: Decreased safety and / r decreased functinal independence related self care, prductivity, and/r leisure ccupatins Issues related t hme accessibility, hme safety, equipment, wheelchairs, seating, pressure ulcer management (preventin and treatment) Issues related t hand functin, upper extremity functin, energy cnservatin, pacing, etc. Issues related t cgnitin, memry, visual perceptin, sensry integratin, etc. Persn Physical Functin ( ding ; sensry, mtr and sensrimtr functins) 3
Standardized Rle Prfile Occupatinal Therapist OT Cgnitive Functin ( thinking ; mental functins bth cgnitive and intellectual, such as cncentratin, perceptin, memry, and judgement) Psychscial Functin ( feeling, scial and emtinal functins, interpersnal and intrapersnal factrs) Spirituality (innate essence f self; expressin f will, drive and mtivatin) 4. Assessment infrmatin may be btained thrugh multiple methds. Methds used, may include, but are nt limited t: Client interview Functinal assessments, cnsisting f an ccupatinal analysis f self care, prductivity, and/r leisure ccupatins. Functinal assessment includes in-depth task analysis. Standardized Assessments t screen cgnitin, visual mtr abilities, perceptin, hand functin, sensry integratin, etc. 5. Identifies the client, based n each unique situatin, and identifies the clients supprt system (e.g., family, significant thers, caregivers, cmmunity, etc.) 6. Advcates with client t establish psitive first cntact, cnsults n ptins fr service; educates and cllabrates t establish/remind client f previus signing and dcument cnsent. 7. Engages with client t build rapprt and the relatinship, clarify values, rganize a schedule and places t meet fr assessment. 8. Cllabrates with client t identify pririties fr assessment and pssible expected utcmes 9. Selects an apprpriate theretical apprach t address the client s ccupatinal perfrmance issues 10. Dcuments and cmmunicates pertinent infrmatin in a timely and cncise manner. 11. Mnitrs, thrugh assessment data, the nging status f the client. 12. Recgnizes changes in ccupatinal perfrmance and engagement, functinal abilities, and health care needs and adjusts the care plan accrdingly. 13. Cllabrates with members f the healthcare team and client t cllect, validate and expand assessment data. 14. Initiates discharge planning with the client, the client s supprt system, and the health care team. Planning: 1. Engages in critical thinking 2. Re-evaluates and adjusts theretical apprach(es) t fit with the client s Occupatinal Perfrmance Issues (OPIs). 3. Analyzes assessment data t identify the client s ccupatinal perfrmance issues, strengths and weaknesses. 4. Interprets the assessment findings fr the client, his/her supprt system, and/r the health care team. 4
Standardized Rle Prfile Occupatinal Therapist OT 5. Engages the client in the gal setting prcess t identify the client s pririties. 6. Initiates planning and establishes shrt and lng term gals, expected utcmes, a plan f care, and a discharge plan. 7. Thrugh cllabratin with the client, develps the plan f care based n the analysis f assessment findings, chsen theretical appraches, clinical best practices, and the client s visin fr his/her life pprtunities. 8. Applies knwledge f pertinent Occupatinal Therapy and related healthcare research and evidence t care planning; uses current knwledge t justify plan f care. 9. Integrates interdisciplinary and multiagency factrs int the care plan. 10. Negtiates and cmmunicates with the client, his/her supprt system, the health care team, and service prviders when there is a difference between the care plan and the wants, needs and strengths f the client. Implementatin: 1. Carries ut assessment, plan implementatin, discharge planning and educatin in accrdance with DHA plicies and prcedures, the Occupatinal Therapy Cde f Ethics, the Natinal Occupatinal Therapy cmpetency requirements, and the Occupatinal Therapy Act f Nva Sctia. 2. Engages the client in interventins with an aim t maximize ccupatinal functining and minimize barriers that impede ccupatinal engagement. Implementatin f the plan invlves prmtin f safety, chice, and risk engagement. 3. Interventin may include ne r mre f the fllwing: remediatin, adaptatin, cmpensatin, preventin, health prmtin, r educatin. Interventins typically target the persn, ccupatin, and envirnment cllectively as these elements are inter-related. Occupatinal therapy interventins may include but are nt limited t: Engagement in graded self care, leisure, and/r prductivity ccupatins t remediate and practice functinal skills, develp adaptive techniques, and ptimize ccupatinal engagement Adaptive equipment fr mbility, bathing, feeding, dressing, cking, cleaning, wrk, play, etc. Seating, wheelchairs, psitining aids, and pressure management (reductin/relief) devices Splinting Educatin fr the client, and his/her supprt system Therapeutic activities that aim t imprve strength, endurance, fine mtr skills, dexterity, pinch, grip, balance, etc. as they relate t ccupatinal functining. Advcacy fr plicy level r system level change 4. Engages the client in treatment n a ne t ne basis r in a grup frmat as apprpriate. 5. Interventins may take place in the medical surgical unit, r in ther functinal envirnments (e.g., hme, schl, cmmunity lcatins, wrk) relevant t the client 5
Standardized Rle Prfile Occupatinal Therapist OT 6. Delegates apprpriate treatment activities t an Occupatinal Therapy assistant, ccupatinal therapy aide, r ther members f the health care team. 7. Identifies the need fr and crdinates hme and cmmunity based ccupatinal therapy interventins, t maintain and enhance the perfrmance f the client in their wn envirnments. 8. Cllabrates and cmmunicates effectively with client, his/her supprt system, team member(s) and internal/external resurces t implement and crdinate plan f care/services. 9. Teaches and caches clients and families in a flexible and creative manner using accurate and cnsistent infrmatin. This may r may nt include the develpment f educatinal materials. 10. Articulates ratinale fr decisins that are based n clinical best practice, current thery and research Evaluatin: 1. Evaluates, cmmunicates, and dcuments expected and unexpected respnses t care, t the client, his/her supprt system, and the health care team. Evaluates and mnitrs brad utcmes including healthy living, and reducing hspitalizatin. 2. In cllabratin with the client, his/her supprt system and the health care team, mnitrs client s respnse t interventin and mdifies/grades treatments, care plan, and discharge plans, as indicated. 3. Discusses bservatins with and makes recmmendatins t interdisciplinary team and leaders t influence prgram develpment/evaluatin. 4. Maintains an accurate accunt f care given thrugh clear, cncise, written and verbal cmmunicatin and evaluates, cmmunicates and dcuments client respnse t care. 5. Cntinuusly engages in critical thinking, and evaluates plan f care and makes revisins t plan as necessary in cnsultatin and cllabratin with ther members f the health care team, client, his/her supprt system. 6. Cnsults, cllabrates, advcates, educates and engages the client t ptimize services. 7. Prtects client and family cnfidentiality, privacy and creates an verall envirnment that is safe and secure 8. Terminates Occupatinal Therapy Services in agreement with clinical best practices, and/r when maximal therapeutic utcmes / functinal gains are achieved. 6
Standardized Rle Prfile Occupatinal Therapist OT Care Crdinatin fr a Client r Grup f Clients: In an acute care medical/surgical unit, the OT may serve as the crdinatr f care within the care delivery team The members f this team vary depending n the needs f the client ppulatin. In this rle the OT will: Prvide leadership at the bedside team level fr ensuring that an integrated interdisciplinary plan f care is created as early as pssible in the client experience fr scheduled and unscheduled clients; Fcus n ensuring that the client care experience is crdinated and integrated within an interdisciplinary mdel f care, bth within acute care and acrss the cntinuum f care. Assume respnsibility fr assessing, planning, implementing, directing, supervising, evaluating direct and indirect care, and evaluating client utcmes. Serve as a key resurce t the family and client Organize client and family cnferences as required t ensure active invlvement in the develpment f the plan f care as well as the nging management and mnitring f prgress Facilitate decisin making thrugh renewed prcesses f cmmunicatin including scheduled runds as well as ad hc meetings t ensure timely flw and prgressin f the nging stay and discharge Identify barriers t smth flw and timely prgressin f the nging stay and review with the team t rectify issues at the earliest pssible mment. Facilitate and crdinate referrals based n needs Ensures client/family educatin by an apprpriate persn Participate in direct client care delivery as per their defined scpe f practice Other pertinent infrmatin: As a part f their emplyment, Occupatinal Therapists; may engage in ther key tasks including, but nt limited t: 1. Cmpletin f wrklad measurement statistics 2. Participatin in and /r leadership f: a. Prgram planning b. Research c. Cntinuus quality imprvement initiatives d. Cmmittees e. Staff educatin 3. Orientatin f new emplyees 4. Facilitatin f student clinical internships 5. Safety initiatives 6. Accreditatin 7
Standardized Rle Prfile Occupatinal Therapist OT APPENDIX 1: Supprting Dcuments 1. Canadian Mdel f Occupatinal Perfrmance (CMOP) 2. Occupatinal Perfrmance Prcess Mdel (OPPM) 3. Occupatinal Therapy Act f Nva Sctia 4. Canadian Assciatin f Occupatinal Therapists (CAOT) Cde f Ethics 5. Essential Cmpetency fr Occupatinal Therapists 6. Canadian Assciatin f Occupatinal Therapists (CAOT) Supprt Persnnel Guidelines 7. Canadian Assciatin f Occupatinal Therapist (2007). Prfile f Occupatinal therapy in Canada. Available at : http:///ww.cat.ca/default.asp?pageid=36 8. Twnsend, E.A. & Platjk, H.P. Enabling Occupatin II: Advancing an ccupatinal therapy visin f health, well-being and justice thrugh ccupatin. Ottawa, ON: CAOT Publicatins l ACE. 8