Topics and Procedures to Review for Acute Care Fieldwork & Job Occupational Therapy

Acute Care Topics Review Fieldwork

A list of topics to review before, as you start, and during your fieldwork. You may not able to review some of these topics until you begin, so review what you can beforehand. A very good resource is the Occupational Therapy in Acute Care book (Amazon Affiliate Link). Some topics may not apply depending on your placement, setting, facility, and clinical instructor. This is not a complete list. Don’t be overwhelmed by this list. Good luck!

Hospital

  • How to respond to hospital codes, e.g. fire alarm -> RACE
  • The types of units in a hospital that OTs work in
  • The progression of care in a hospital for OT
  • Location of exit routes
  • Times of nursing shift change and medication pass (“golden hour”)
  • Hospital staff and roles (including CNA, social worker, specialists, palliative care, coordinators)
  • Locations of supply room and OT supplies
  • Distances of hallways for functional mobility documentation
  • Codes to access rooms, supplies, doors
  • How to call a code to alert staff

Infection Control

  • Proper handwashing technique
  • Where to find references for exposures or chemical spills
  • Standard precautions vs. contact vs. airborne vs. isolation; COVID-19
  • Donning and doffing PPE (gloves, gown, masks (including N-95), face shields/goggles, hairnets; including sequence of
  • How to disinfect, what to disinfect with, and how long to wait after disinfecting
  • What is re-usable vs. single-use
  • What to do in case of exposures (facility-specific)
  • What to do when a patient falls (fingers crossed!)

Documentation

  • EMR system
  • Level of assist for ADLs, transfers
  • Components of a screen
  • Components of an evaluation
  • Components of a re-assessment
  • Components of a treat
  • Components of a D/C from OT
  • Documenting refusals and medical exceptions to OT
  • Documenting co-treats with PT
  • AM-PAC 6 Clicks outcome measure, or other measure used by facility
  • Occupational profile
  • Finding the patient diagnosis (you will often have to dig around in MD notes for this)
  • Treatment time for billing and Rule of 8’s
  • Recommendations for DME
  • Setting a specific frequency and duration of OT
  • Referrals to services (possibly PT if no PT was ordered)
  • Finding orders, placing orders

Chart Review

  • Patient’s current room location
  • OT orders, order expiration
  • MD orders
  • Precautions
  • Interdisciplinary notes (MD, PT, RN, SLP, SW/case manager, OT, etc.)
  • Imaging results (e.g., recent DVT rule-out, x-rays, CAT, Ultrasound, MRI)
  • Recent HOLDs to therapy and why
  • Lab values
  • Scheduled procedures and surgeries for the day
  • Dysphagia level (New IDDSI system)
  • Most recent level of assist
  • What A/E, devices to bring, e.g. FWW and sock-aide
  • Pain level and timing of pain medications
  • Psychosocial symptoms, restraints
  • ADLs
  • OT treatment plan
  • Discharge plan

Evaluation

  • Diagnosis for hospital admission
  • Past medical history (pertinent information)
  • Handedness
  • Adaptations prior used e.g., hearing aides, glasses
  • Vision (smooth pursuit, saccades, peripheral, visual acuity, field cuts)
  • Perception (e.g., midline orientation, neglect)
  • Hearing or hard of hearing
  • Sensation (light touch, pain)
  • Proprioception
  • Balance scale (sitting, standing, static, dynamic)
  • Coordination (mostly upper extremities – RAM, finger to nose, thumb opposition)
  • Dysphagia level
  • Cognition (attention, memory, safety, problem solving, executive function)
  • ADLs: Feeding/eating, grooming, dressing, toileting, bathing
  • IADLs: I vs. assist
  • Prior Caregivers or help with any chores?
  • Prior level of function
  • MMT
  • ROM
  • Functional mobility for ADLs
  • Vital signs (minimum 2 readings)
  • Pain (location, intensity, type, relief)
  • Environment (e.g., 2 story with 1 flight of stairs (no handrails), ramped entry)
  • Existing DME and mobility devices (e.g., FWW, SPC, Drop-arm commode, grab bars in shower, reacher-grabber, hand-held shower wand)
  • OT Treatment plan
  • Referrals
  • Time seen for OT that is billable
  • Discharge plan
  • SOAP note

Discharge Planning

  • Home vs. continue acute care vs. ARU vs. SNF vs. Board & care vs. other
  • Estimated length of stay
  • Patient progress
  • Family training
  • Equipment needs
  • Barriers to discharge
  • Community resources
  • Insurance
  • Communicating with staff (PT, RN, SW, MD, manager)

Conditions and Topics

  • Stroke, TIA, mobilizing after t-PA, splints for, kinesiotaping for subluxation
  • Edema management
  • A&Ox4 questions (name, place, place, event); confused
  • Hydrocephalus, NPH
  • Hematoma, ICP, Intraventricular hemorrhage
  • Coma scale (if ICU) – Glasgow coma scale, RAAS
  • Drains, management, e.g. JP, chest tubes, shunts
  • Concussive syndrome
  • Hemi-inattention, Neglect
  • TBI, Rancho levels
  • Seizures, Epilepsy, helmets, management of
  • Craniectomy, Craniotomy, Cranioplasty (differences)
  • Clipping, deep brain stimulators, coil embolization, evacuations
  • Neurogenic bladders
  • Dementia, Alzheimer’s, when to D/C from OT, caregiver training for
  • A-fib, Pacemaker
  • MI, CABG
  • COPD, bronchitis
  • Pneumonia
  • Asthma
  • Cystic fibrosis
  • Pulmonary edema
  • Pneumothorax, Hemothorax, Pleural effusion
  • Tuberculosis
  • Sleep apnea
  • Incentive spirometry
  • Empyema
  • CHF
  • All the Precautions
  • Transfers between surfaces
  • Dangling
  • Cancers, Immunocompromised PPE, Cancer grading, Tumors
  • Types of splints
  • Exercise hand-outs; theraband, theraputty, etc.
  • Educational handouts
  • Types of fractures, healing times, splints for
  • ORIF, Ex-fix, Replacements, Intramedullary nailing surgery
  • Atelectasis
  • COVID-19, ARDS
  • Infectious diseases, e.g., MRSA, TB, Osteomyelitis
  • Orthostatic hypotension
  • When to mobilize after DVT (UE and LE)
  • Screening for potential DVT and alerting staff
  • Donning/doffing orthotics and more – TLSO, LSO, cervical collar, knee immobilizer, AFO, arm slings
  • Wheelchair use, parts, safety, types needed based on Dx
  • How to use a Sara Stedy (This is the correct spelling)
  • How to use a hoyer lift (ceiling, battery operated, hand crank)
  • Slipp sheet transfers
  • Hovermat transfers
  • Adjusting and installing platform walkers, residual limb supports in W/C’s, FWWs, etc.
  • Weight limits of devices and equipment
  • Oxygen use and administration (nasal cannula, O2 tank, adjusting [if allowed])
  • Hospital bed operation (including bariatric beds)
  • Fall scales
  • Psychosocial conditions, Conversion disorder, Adjustment to disability
  • Substance abuse, ETOH, CIWA protocol
  • Neurodegenerative conditions (ALS, GBS, MS, Myasthenia Gravis, etc.)
  • CRPS
  • Pacing and energy conservation
  • Therapeutic breathing
  • Managing lines and equipment (SCDs, bed alarms, oxygen, foley catheter bags, drains, tubing, etc.)
  • Taking vitals (automatic and manual methods), pulse oximeter use
  • Amputations, Figure 8 wrapping, residual limb care
  • Diabetes symptoms and management
  • Foley catheters, Condom catheters, Self-cathing
  • Purewick uses and precautions
  • Skin breakdown, bed sores
  • Hemi-Dressing techniques
  • Endocarditis, Myocarditis, Aneurysms, Angioplasty, Cardioversion
  • Left ventricular assistive devices
  • Common medications
  • Hypertensive and hypotensive emergencies
  • Renal failure and the 2 types of dialysis
  • DVTs, Pulmonary embolisms
  • Pulmonary rehabilitation (Common Dx, COVID-19)
  • Spinal cord injury, Syndromes, ASIA scale
  • Tone, ataxia, dysdiadochokinesia, modified Ashworth scale
  • Burns
  • Tying a quick-release restraint
  • Applying and removing splints
  • Caregiver training

OT Advocacy

  • What is OT
  • Who needs OT
  • Who does not need OT
  • Role of OT in team meetings
  • Difference between OT vs PT
  • OT outside of acute care
  • OT resources