The Beginning of the End?

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It goes without saying the tireless effort that hospital staff, long term care facilities and so many healthcare professionals and nonhealthcare professionals have put into this effort. Everyone in almost every industry has made a sacrifice for us to get to this point. Astrazeneca-Oxford, Moderna, and Pfizer releasing their news about a vaccine and its effectiveness has been absolutley astonishing. We heard that the fastest vaccine to market was 3-4 years, and there were calls that it would take 12-16 months before we had a vaccine for a coronavirus (https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html). To think that within 9 months we have 3 vaccines candidates that are over 70% effective, 94.5% effective and 95% effective, respectively (https://apnews.com/article/astrazeneca-vaccine-third-cheaper-oxford-c99d26eb2946f6fde45a1edc002ff028). It will be interesting to read how this came together so quickly when we look back on it however I think that it goes without saying – a collective sigh of relief for returning to normalcy.

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I realizethat there’s so much work that needs to be done before we get to this point. A strong coordinated effort by many organizations for us to get to the finish line. Being in a hospital setting I know that all staff are stressed to the max trying to help others. It’s been an all hands on deck – everyone has mobilized for one common goal – to serve others. I’ve seen some unfortuante cases over the past few months and especially the past week, however I think one thing that I’ve loved in this hospital and will always remember is the hospital staff from physicians, nurses, therapists, volunteers, non-clinicians and so many other great people who gave everything they had each day. We may not feel the best, we may get stressed out – but it’s the teamwork and remembering why we do what we do that keeps us motivated. Hopefully this is the beginning of the end for the coronavirus, however I hope that the teamwork and working relationships that we gained continue after this is all said and done.

Back on the Grind

Tomorrow is bittersweet. I’m thankful for my health, the health of my family and co-workers. I learned a lot about myself over my quarantine. Back to the hospital on Thanksgiving – I’m thankful that Pfizer, Moderna, and AstraZeneca have announced highly effective vaccines and science accomplished something few thought would happen in less than 9 months. There’s still so much work to do over the next few months however You feel a sense of optimism and now an end is in sight.

Everyone in healthcare fields and non-healthcare fields have all had to sacrifice something and I’m thankful for everyone’s collective contribution to a better world this Thanksgiving.

Acute Care: Considerations Before Evaluation

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Hospital Culture

I could provide you an outline of the acute care day and I would say that it is probably pretty familiar most places that you go. Determine your patients for the day, chart review, check with floor nurse, evaluate patient, handoff, write evaluation, and get ready for your next one.

Determine your patients

In today’s world of technology, you might be surprised to know that up until 2-3 months ago, at our hospital our rehab aide printed up the orders and wrote “tags” and we would select patients accordingly. Oddly Covid-19 has pushed us departments to innovate so that multiple people aren’t standing around and use our technology tools to prevent socializing too closely together. Lately, we have been using UI tools to populate the orders and we pick our patients right out off of Epic. We have our system for making sure people are seen, signing off appropriately however I won’t get into those nuances.

Hospital Floors

We are a smaller hospital, not rural however not a big, downtown location either. Recently our hospital made the decision to place OTs, PTs on one floor – we are on telemetry, ICU, CVICU, advanced care unit, inpatient rehabilitation, and/or medical-surgical. Those seem to be the typical floors in most hospitals. We rotate between floors with the exception of inpatient rehabilitation as those have dedicated therapists.

(We might be a unique situation in our hospital. It seems over the past 5 years, Inpatient rehabilitation units are moving towards a free-standing inpatient rehabilitation unit. It’s no longer within the hospital, instead it’s housed in a free-standing hospital where it might be a 40-60 bed hospital with a larger staff dedicated to IPR. I’ve noticed these usually occur as a partnership between a local, nonprofit health system and national, for-profit rehabilitation hospital.)

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Chart Review

This deserves it’s own post however I won’t get too into the nuances on this. The chart review is such a critical piece prior to evaluation. Imagine the day, and in some settings this still occurs, when you had to open a physical paper-based chart and someone else had it?? Then you moved on. Luckily I would think most hospitals and most settings at this time, although I realize this is not everyone yet – an electronic medical record (EMR) system usually helps you access a chart anywhere within the hospitals network. In my hospital system we use Epic however there’s Kerner and other systems out there.

At this point I’m starting to review orders, lab values, Notes by the physician, nursing notes, therapy noted, interdisciplinary care management/social work.

Check for the Order

Always the first thing to check. Was the order written for now? It could have appeared and the ordering physician wants you to see them later. Sometimes we get orders for patients who literally walked through the door. Use your critical thinking skills (and check with the floor nurse) regarding if it’s the appropriate time to see this patient. They may be awaiting a test or a consult from another physician that may provide an opinion, such as the need for surgery.

Lab Values

It’s interesting because in school we learned the pre-determined guidelines for lab values. Once they reach this lab value “you can’t see them,” and what you learn on the job that you didn’t read in the textbook is that other factors come in to play. Every patient is different and while some numbers may read below a range or above a range, it may not necessarily mean this patient cannot be treated. There may be a reason a physician wants a particular patient seen despite a particular lab value out of range. We have to think is it critically out of range, or an abnormally high/low value. Caution may be necessary when approaching a treatment/evaluation of the patient. We have to consider safety with patients – by mobilizing a patient to either sit at the edge of the bed or mobilize within the room, are we placing the patient at greater risk? This is where collaboarting with nursing and obtaining a well-rounded picture of the patient is necessary.

Weight Bearing Status

It’s very critical to get an idea of a patient’s weight bearing if you are seeing a surgical patient or any patient who have fractured an area of their body. We must wait for the consulting physician to place orders. Generally, patients who fracture their humerus/shoulder region generally may get a sling and they will be non-weight bearing. Someone who broke their wrist may be unable to bear weight in their wrist but they can weight bear through their elbow to use a walker. There are many nuanced weight bearing statuses so it’s crucial to understand each one and how that could impact your intervention.

Many times the type of fracture, location of the fracture may give you an idea of what to expect before the ortho consult. Regardless, it is highly recommended to wait before seeing any patient even if the hospitalist has already placed their orders.

Checking with the floor nurse

Occupational therapists may feel a need to “know everything,” however there may be critical pieces of information left out of the patient’s chart. The floor nurse likely knows the answer as they received verbalized reports from the physician, the previous floor nurse, and so on. Many physicians are consulted to see patients and may not have had a chance to place orders or publish their note concerning their assessment of the patient. It is possible neurology wants an MRI to determine if the patient had a CVA because the CT scan was inconclusive. As stated in the previous example, maybe orthopedics consulted the patient and the nurse hasn’t released the new orders for weight bearing as tolerated (WBAT) or non-weight bearing (NWB). I’ve seen it happen a few times where the orders might be pending from the surgery and the surgical physician didn’t confirm anything in their note.

Final Thoughts on Clinical Decision Making

We are all people trying to help our patients. Everyone has that common goal. It is so crucial to be a team player with the nursing, physicians, imaging, respiratory therapy, dietary and housekeeping. Everyone is busy and on a schedule especially with productivity standards applying in the hospital however you can never diminish the importance of safety and great communication. We will all make mistakes along the way, but making sure you have the most information necessary to guide your clinical decision making is critical.

Happy chart reviewing! Drop me a line on what you do for the chart review process, I’m open to reading new ideas.

Occupational Therapist Centralized Application Service (OTCAS)

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Once you think things won’t change, they do. When I applied to OT school, you looked up each school’s admission requirements and followed each one’s guidelines. You felt bad for your references, “Hey I need another reference letter” and then you had to send your transcript out to each individual school. It felt like a never ending cycle of checklists and fees for each little thing.

The game changed.

Enter the Occupational Therapist Centralized Application Service (OTCAS) brought to you by AOTA. Many schools use this platform to help with getting rid of the redunant nature of the application. Applications open on the OTCAS website July 16 and close October 1st, annually. The coronavirus has extended most deadlines until December 1, 2020. Unfortunatley not every university uses this platform however if you plan to apply to multiple schools you will likely find several schools using it. You can upload your observation hours, letters of reference, school attended, transcripts (send each one from every school you attended to OTCAS), achievements, and the actual school’s Occupational Therapy application.

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What to expect with OTCAS – this is not an official guide put out by OTCAS but a breakdown of interacting with the application and making sense of each section.

  • My Profile
    • Your basic information such as email, name, identity, passwords
  • Personal Information
    • You will answer information regarding: contact, citizenship, race/ethnicity, and others misc information such as military, felony/institutional infraction, or previously attended another OT school.
  • Academic History
    • High school diploma, every college you attended or if you took coursework at another school to fulfill requirements for your application
    • Transcript entry: Applicants must arrange for OTCAS to receive a sealed official transcript directly from EVERY regionally accredited U.S. institution they have attended. You cannot fax or provide your own transcript to OTCAS even if you have your own personal copy.
    • Transcript Request Form: It is not required, howeve it is recommended that applicants submit the OTCAS transcript request form for every regionally accredited U.S. institution attended.
  • GPA calculation:
    a. Enter all the GPA for all the courses that you completed.
  • Standardized Tests: Enter GRE score or TOEFL test scores, list each one if you took the test more than once.
  • Supporting Information:
    Evaluations (Letters of Recommendation):
    • Read each application very carefully. Each school may ask for different number of letter of recommendations.
    • OTCAS requires 3 letters of recommendation. Make sure they are sent in well ahead of the deadline to ensure verification.
  • Observation Hours
    Enter all of your occupational therapy (OT) observation hours into the OTCAS
    application.
    • Use “Add Observation Hours” for providing all hours
    • OTCAS does not verify hours, so you may need to use a separate form or document that provides the facility name, location, your state/end date, total hours for verification to the program. Upload this form to the “Documents” tab.
    • For 2020 application some schools may be waiving hours due to the pandemic.
  • Experiences
    There are 12 different topics in which you can include up to 12 different experiences/activities per
    topic. Areas include: employment, extra curric activities, healthcare experience, internships/clinicals, research, teaching experience, and volunteering.
    • Provide specific information regarding your experiences such a the name of facility, contact information, title, start/end dates and the total hours you participated in those activities
    • It may or may not be your professional reference who wrote your recommendation but it may be a good idea to provide some reference or contact to verify your participation
  • Personal Statement (listed as “Documents”)
    • Per OTCAS, “Your personal essay should address why you selected OT as a career and how an Occupational Therapy degree relates to your immediate and long term professional goals. Describe how your personal, educational, and professional background will help you to achieve your goals,”
    • You’re limited to 7500 characters total – this will be the personal statement that goes to every school.
    • Be authentic! Use this as a change to showcase your experiences to schools and why your preparation to apply over the past year has been adequate for being admitted to OT school.
  • Program Materials
    • Every individual school will have their own supplemental materials for their applciation. While the OTCAS will provide you with the common application, once you reach this supplemental section you will then need to provide each school additional information that they require for admissions.

Good luck guys! It’s such an exciting time when you’re applying yet a stressful time. You always think to yourself, “Did I do enough?” “Should I have written it like this?” You will always second guess yourself throughout the process, but be confident that you put for your best effort and most complete application for yourself.

Preparing for Occupational Therapy Level II Fieldwork Placements in 2020 and 2021

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Not to scare anyone with the image above. Unfortunately, this picture has some legitimacy. It is not an uncommon site these days on an acute care floor. This image is NOT 100% accurate with the level of PPE being worn by this student, however. Most hospitals, that I know of, will not allow student clinicians to work with patients who have been positively diagnosed with the coronavirus. All patients are being tested for coronavirus with patients room being properly identified using with a green (negative), yellow (pending), or red (positive) tag. Moreover at my own hospital clinicians and student clinicians are wearing eye protection and surgical masks with the increased cases that we are witnessing in November 2020 going into December 2020.

I am the Site Coordinator of Clinical Education (SCCE) at my my hospital for the Rehabilitation Therapy department including Occupational Therapists, Physical Therapists, Recreational Therapy, and Speech Language Pathologists. It is an extra role that I started in April 2020 in addition to my normal clinical job duties.

I’ve started to get the emails very frequently over the past 2-3 weeks with people asking me about quarantining, Personal Protective Equipment (PPE), what to wear, where to park. You name it. And I can’t blame anyone – we are in a stressful situation already, now you have go into another setting and learn a whole new set of norms.

Quarantine – “Do I have to?”

Some of you will be traveling out of state to your clinical sites. This is definitely a specific question for your clinical site because there’s a confluence of factors from state guidelines, CDC guidelines, and even your city or county guidelines can contribute to the answer. In my state it depends on the out of state visitor and the current infection rate of the state they left. Every state, county, and city and even each hospital/clinic/site might have its own policy. It definitely needs to be determined prior to starting and it may change in the weeks, months ahead. One thing is for sure – if you have symptoms prior to starting or during your clinical, report to your clinical instructor (CI) immediately. No one wants you to jeopardize your health or the health of your patients.

Personal Protective Equipment (PPE) – “Do I need to bring my own PPE?”

I’ve had students ask me if we will provide equipment or if they have to provide their own equipment. At one point I know that hospitals sent home students as they ran out of PPE and we were in dire conservation mode. Luckily, the landscape for PPE procurement has changed for the most part. It may be a good question to ask for the smaller clinics regarding their equipment however with a hospital and places with resources – a surgical masks, gloves and a gown (depending on your setting) should not be hard to get.

Misc.

There may be other nuances with each site. Most people ask about lunch, what to wear, and other general questisons that each site will have to answer separately. Rule of thumb: polo shirt (I’m not sure why the polo has been such a fixture in inpatient rehabilitation settings, even in some acute care hospitals) and solid color pants. You may be lucky and your setting allows scrub pants – much more comfortable than business casual slacks!

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Get your head in the game

You are wrapping up your finals after a chaotic first semester of hybrid courses, social distancing, and unconventional guidelines. Everything you have worked hard for has culminated to this point where you venture out into your fieldwork placement site! Take a deep breath! This will be an exciting time to take all of the things you read about in your textbooks, all those research articles, all that research projects, all the case studies you read and wrote your treatment plans – it is showtime!

You aren’t expected to be an expert

I think that some students come in afraid to ask questions. Maybe you don’t think this is you; and I hope that all students feel that they can ask their clinical instructor (CI) questions. Maybe there’s a personality conflict, or maybe your CI will not feel approachable. If that’s the case, I am sorry to hear that! Hopefully you will be in a clinic or setting where you can receive some feedback from other therapists if you feel it’s difficult to interact with your instructor. As a student, you may be observing more so your first week. Be thinking about why and how the leading therapist approaches problems.

Customer Service

None of us are born experts – it took years for us to get here and achieve our level of expertise. One area that I notice with students are the soft skills, the speaking to patients, introducing yourself, the confidence when speaking with patients, and the general customer service type of skills that goes with any job. You will make mistakes, your interventions may not execute the way you wanted it to – it’s okay! Everything you say and do may not be perfect, however you will learn and remember the end goal of this clinical rotation…

Remember the goal: Entry-level Occupational Therapist

Your clinical will be scored using the Fieldwork Performance Evaluation by AOTA, and the criteria is for you to be an entry level occupational therapist. You guys have all the potential – you know all the latest, greatest reserach in addition to your own research projects in school. You’ve learned all fundamental, basic skills from your respective Occupational Therapy programs and you will be taking those skills to the clinic. The hard thing is implementing those broad array of skills, learning how to work with people, knowing when to use and when not to use certain skills and techniques. Your clinical instructor will guide you through those things, the time management, working with multiple patients/clients in an 8 hour day will be the skills you probably did not learn.

I was at a workshop where an OT clinician named Dan Eisner presented and he described his book, Clinical Success Formula. It provides amazing content for you to gain perspective and implement strategies for you to get through your clinical site. There is affiliate linking however you can purchase the book used, new (https://amzn.to/3nMRTGj), Kindle format (https://amzn.to/336jCd2) or even get the book free through Kindle Unlimited (included with your Kindle Unlimited membership). I read the book a few years after completing my fieldwork and it’s a fun, quick read!

Occupational Therapy – The gameplan for applying

“I believe luck is preparation meeting opportunity. If you hadn’t been prepared when the opportunity came along, you wouldn’t have been lucky.”

Oprah Winfrey

Life seems linear when you’re in school. On your first day you get a syllabus, it’s your guide for the entire semester! It holds the due dates, when you can anticipate a quiz, exam. Really – nothing should come as a surprise over the semester if you’ve been paying attention. Inevitably the class may get behind and some assignment due dates get pushed back. (Granted I didn’t attend school during the coronavirus so you all you guys can tell me how that goes.) Regardless, everything feels pre-determined.

As pre-occupational therapy students, we are tyring to determine which schools we want to apply to. They have their own nuances with pre-requisite coursework, some have interviews, some don’t; however one thing that’s usually non-negotiable: observation hours

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Observation Hours

  • Start with a plan – look at every school and figure out how many hours each school is requesting. some may only ask for 20 hours, the gold standard is typically 40 hours. Exceed that number of hours if possible. It may be tough with coronavirus however the coronavirus has always allowed people to become creative with virtual observation hours and schools allowing you to count substitute hours. Youtube is an invaluable resource for viewing videos with great, targeted intervention strategies. If you want to look up early intervention, pediatric OT, school-based occupational therapy or even look up neurodevelopmental occupational therapy rehabilitation with adults – it’s all there!
  • Shop early” – I understand everyone has a Plan B, Plan C, Plan D and things comes up however if you have an interest in occupational therapy early on, you should defintiley seek out OT clinicians in a variety of settings. Imagine back in the day pre-LinkedIn, pre-Instagram, pre-youtube having to call a clinician’s work phone or figure out someone’s work email and hoping they checked it that week. Hospitals may have the corporate compliance hurdles to jump (e.g. HIPPA compliance), however the little pediatric/small clinics and independently-owned clinics might be a little easier to shadow. We are OTs – we love to help people if we can! Sometimes, unfortunatley, we cannot. Email, message us on Facebook, message us on LinkedIn, our blogs, tweet us – it may not be a good time, but you never know. It could be a quick way to connect. The only hurdle is contacting them (and maybe a coronavirus protocol or two).
  • Continue the relationship – if you find a setting you like, it certainly would not hurt to keep the relationship going and exceeding the amount of contact hours that you need for applying to school. I had someone as young as a high school senior who observed with me 1 day/week for several months until the coronavirus changed protocol.
  • Personal statement – It is likely that you will have a personal statement to write. Keep notes about situations, describe what you observed, and why you are passionate about it. You will come across as authentic if you have a specific, real scenario that demonstrates why you are passionate about entering the occupational therapy field.
  • Letters of Recommendation – Think about who you will need these letters of recommendation from. You may only need professors or professional references. You may need one from an OT. If you went to a particular setting or clinic you will build a rapport with the therapists who can vouch for your organization, commitment, and high level of interest!
  • Questions – I love questions from students. Every question is important and it’s worth asking. It says to me that you’re thinking and it’s appreciated that you ask after the session has ended. You can think about your own questions, however this is observation. I had years of training and experience so I would not expect someone getting their initial observation to understand what to ask. If you want to ask a few basic questions, maybe even think along these lines:
    • How did you select your interventions? (I would discuss the client factors, client goals)
    • Could you have done anything differently?
    • What are the patient’s goals?
    • How do you describe occupational therapy to your patients?
    • How can I learn more about occuapational therapy? How can I learn about the intervention that you used? (never anything wrong with learning or maybe finding a starting point to watch videos if an area interests you. You may find videos made by a therapist in a oupt clinic or hospital nearby!)

Otherwise, everything seems stressful in the moment. Once your plan starts to come into action, you create a routine to attend observation hours and build a relationship, it will be your first step in your OT journey in the books. There’s other creative ways to gather observation hours and enrich your experience whether it’s through volunteer opportunities (children’s hospitals always seek out volunteers), summer camp clinics (whether it’s volunteer or employed), you will have to determine the situation right for you and your plan!

Intro

My name is Ryan and I’ve been an Occupational Therapist for 5 years. I started in a SNF for about a year and transitioned to the hospital setting where I’ve been involved in acute care/inpatient rehabilitation ever since. I thought that I would continue striving with excellence that I had when I started. Every time I attended a conference, an after work continuing education event, or any type of course over a weekend I came back with the therapist “high” that I was going to be the best therapist I can be. The incredible blogs that I’ve read over the years in addition to the tireless, relentless work that you see other Occupational Therapist out there doing. Moreover, I stopped challenging myself to be a better therapist. I stopped reading articles, I stopped looking at research, I stopped communicating with my professional organizations.

This blog is to give myself that shot to rethink, refocus, and continue to motivate myself and hopefully evolve into understanding new perspectives of OT. I’m a very introverted person. Some people are surprised to learn that; I would say when it comes to working through problems I’ve never been the most team-oriented person and it’s been a large weakness. I think that I was drawn to blogging, video, and social media to interact with a larger audience of like-minded clinicians in order to discuss new, different ideas.

What topics do you think you’ll write about? Anything and everything related to OT or areas that complement OT will be on the table. We are limited by our own limitations as therapists and we should strive to integrate new ideas even if it seems unrelated or uncomfortable at first.

Who would you love to connect with via your blog? I want to connect with like-minded therapists – no matter the discipline to share information, knowledge, ideas about disrupting

What will things look like next year? For now I’m excited to present my own ideas and hope that larger discussion and responses occur as a result. I’d love to get into Podcasting. I love to listen to interesting conversations and it would be cool to get involved further in audio and video. I’ve discovered other great OTs over the years however I think that there’s even more content and different perspective I’d love to hear and learn from!