Haydel Consulting Services LLC

As promised, here are the answers to Monday’s quiz.  See the previous post below this one if you missed out on the quiz.  In fact, stop reading now and answer the quiz if you haven’t already done so.

The first response was that therapy should be provided under the management of a physical therapist.  This makes perfect sense to me.  And in agencies large enough to have a separate therapy department, I highly recommend a director of therapy.  However, it is clearly stated in the Conditions of Participation for Home Health and most state minimum standards that all care in an agency is provided under the direction of the Director of Nurses.  This is very challenging for many nurses, including myself.  How do we manage therapy if we don’t know exactly what it is that they do?  Looking at the larger picture, is it so much different than a CEO of a major airline managing pilots and mechanics when he or she has never flown or repaired a plane?  In order to manage therapy as nurses, we must cultivate trusted sources and work with therapists who do not feel threatened when we question their work.  We learn a lot this way!

The next response has to do with visit frequencies.  Certainly therapy plans of care that include 7 or 14 visits are financially lucrative and there is nothing at all wrong with keeping payment criteria in mind when determining frequencies.  In fact, it is important to be aware of these numbers in an agency that wants to do well financially.  However, the ultimate frequency that the patient receives should be the one that best reflects the patient needs.  Always.  If a patient needs 13 visits, then that’s what the patient should receive. (However, show me a patient who requires 13 PT visits and I bet I can find a need for a few OT visits in the clinical documentation!)

The third answer involving wound care was correct.  It is within the scope of practice for physical therapists to perform wound care.  In fact, physical therapists can do certain things that nurses cannot such as sharps debridement in most states.  This can work to an agency’s advantage two ways.  First in wound care patients receiving physical therapy, duplicate visits can be eliminated by having the therapist assess and perform wound care on days when PT is ordered.  Secondly, consider a PT wound care program if you are not suffering from a lack of physical therapists.  Choose one or two interested therapists and invest in advanced wound care training for them.   If your agency decides to take advantage of either of these advantages of therapists performing wound care, be sure that you specify that physical therapy should be doing wound care on the plan of care.

The last answer about OASIS was also incorrect.  Many agencies choose to have the nursing staff perform all OASIS assessments.  This may be a sound strategy especially when physical therapists are in short supply.  However, in an agency where a large number of patients are admitted for physical therapy only, consider training the therapists to perform the OASIS assessment.  This eliminates the need for using a nurse to do an assessment and then write a care plan based upon the PT’s assessment.

If you have any questions about the answers to yesterday’s quiz, please post them below in the ‘responses’ box or email us at haydelconsulting@bellsouth.com.