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Occupational Therapy in the ICU
3 Problems to target: prolonged bedrest and ventilation, sensory deprivation
and stress, and cognitive impairment
OT TreatmentsOT Treatments
Upper Extremity Exercise, positioning, splinting
Early participation in functional activities and ADLs
Cognitive stimulation
Use of technology for alternative treatment interventions
Participation in ICU diaries
ICU DiariesICU Diaries
Purpose: to fill memory gaps and provide an understanding of what happened in a chronological narrative account.
Connects facts with autobiographical memory (or lack of) to make sense of a time that may have been dominated by delirium or confusion.
A way to communicate the experience with others.
Communication Communication technologytechnology
Encouraged use of and iPad and/or Eye Gaze System for communication while on vent or trach
Use of iPads for fine motor coordination tasks and UB strengthening
Use of iPad and/or Eye Gaze System for cognition activity
Program GoalsProgram Goals
Designated OT’s in the ICU
Prioritizing ICU patients
Advocate Team Approach to patient care
Participate in Research Log Book by documenting highest level of ADL performance (sitting or higher)
Additional Additional ResourcesResources
Family involvement menu, Mobility guidelines, Engagement tool
Family Involvement Family Involvement MenuMenu
Welcome: Welcome to Mayo Clinic hospital ICU
Purpose: We believe that you know the person we are serving better than we do. We would like to invite you to participate in your loved ones care.
Contract: We would like to participate in the care of this person with the following tasks. We are receptive to instruction.
tasks: incentive spyrometry, bath care, eating care, exercise, etc
Mobility toolsMobility toolsMobility Board / Quality Board Board / Quality Board
Guidelines/fact sheets
levels of consciousness (assessment, activity, therapy)
Is my patient ready to start mobility activity today? (neuro, respiratory, cardiovascular screens)
Progressive Mobility tolerence screen
Progressive Mobility decision tree for PT /OT consults
Function toolsFunction tools
standardize as much as possible
grip test
6 minute walk test
Quality of Life measure
EngagementEngagement
Operant Conditioning: learning that occurs through rewards and punishments of behavior (ie: positive and negative reinforcement)
Motivational Interviewing: using patient goals or values to shape care
Resist righting, understand patient motivation, reflective listening, empowerment
as apposed to using goals centered on external factors
Engagement toolsEngagement tools
Done in collaboration with whole team
Starter: Hand-off communication tools for therapist to therapist and for therapist to / from nurse
Advanced model: Bundle system-wide an interdisciplinary approach to communicating function so there is seamless progress when patients move unit to unit
SafetySafety
Study concluded out of 5300 PT sessions with 50% sitting or higher activity level, there were only 34 potential safety occurrences (89% of them were changes in vital signs). There were no major events such as catheters or trachs removed or MI’s. There were 2 assisted falls and 1 unassisted fall. Only 8 events that needed minimal intervention.
Potential area of study as we proceed with our culture of mobility.
Thank YouCarmen Cononie, Kristien Daron, Rebekah Davis, Hali Cole