Acute Care Occupational Therapy: The Sandwich Method
Written by Dominic Lloyd-Randolfi, Published on March 6, 2017
Acute care occupational therapy is a common career path for new OTs. Yet, it is covered very minimally during OT school.
The sandwich method for acute care occupational therapy is an easy way to remember the steps to help new grad occupational therapists find success in the fast paced environment.
Your top piece of bread
This is where you are gathering all of your information. You will want to do your best getting as much past and recent medical history by reading the chart.
Depending on the patient and their diagnosis, make sure you take a glance at critical lab values, blood pressure, and heart rhythms to make sure you are providing safe care.
You might even look to see what pain medication they are on or if they have any lines and tubes. Nobody likes a surprise! Managing lines in a small hospital room is arguably more difficult than the transfers. If you ever have a question, just hit the nurses’ button and ask for help.
This is a great opportunity to check in at the nurses' station. Think of them as the gatekeeper of care to your patient. Nursing is monitoring the patient throughout the day and they may know something you might not and suggest OT come back at a later time.
Make sure you double check your orders and the patient’s activity level. There is always a possibility of a discrepancy. For example, an order might say “weight-bearing as tolerated”, but a surgeon might write "non weight-bearing" in their documentation.”
The meat and cheese
Here is the good stuff. The intervention. The actual reason you are here! Occupational therapy is so multifaceted that you could be working on any number of issues for almost any medical condition.
Hospital stays are becoming shorter and shorter, so chances are you are completing an evaluation. Your main job here is to use your professional reasoning and clinical judgment to decide if this particular person is safe to return home.
Think about some of these factors. Do they have the durable medical equipment needed or is there assistance at home? If not, it is up to you (and the team) to decide between discharge possibilities such as inpatient rehab, skilled nursing facility, or home health.
Other times it can be tricky. Say you have a patient with COPD or a CABG and the physician's orders say “ambulate.” Well, that isn’t our job, but it is in the client's best interest to get physical activity to improve their medical condition.
Instead of documenting "functional mobility," try walking your patient down to a small kitchen or lounge and have them prepare a cup of tea. It is occupation based and you are fulfilling what the physician asked of you!
Acute care occupational therapy can present obstacles with keeping treatments occupation based. And that is ok. Often times working on transfers or functional mobility is necessary to the treatment plan and returning to their occupation of choice.
End piece of bread
Here is the end of your treatment or evaluation. Head back to the nurses' station or the office and type up that note! You may even go straight to another patient, and that is fine. Some facilities may ask that you complete your documentation as close to the end of treatment as possible so that other members of the interdisciplinary team can know your thoughts.
Always make an effort to chat with the nurse covering that patient and let them know what progress was made or what your first impressions are. Good communication can really be the difference in coordinating care.
Remember what information is relevant to specific clinicians. Doctors, nursing, physical therapy, social workers, and speech therapy are all looking at different aspects of the patient’s performance. So, when you are talking with the PT, they are looking for you to discuss balance and functional mobility, not if the patient can don/doff their own shoes.