Congratulations to Keystone’s Newest CTOs

MP Celebrate

By Jon Anderson, Therapy Resource, Texas
I wanted to take a few moments to celebrate our newest CTOs (Chief Therapy Officers) in Keystone. The CTO designation is the highest designation a therapy leader in the organization can receive; it is a tall order to be in this elite club. Please join me in congratulating this elite group of Texas leaders!

There is so much to say about these two incredible ladies, but I’ll keep this short and just share a few highlights.

Cara Koepsel, SLP, DOR, CTO, Golden Acres, Dallas, TX
Cara became the DOR at Golden Acres in May 2018, after being one of our first DORITOs (Director of Rehab in Training) in Keystone, and then successfully transitioning to DOR (Director of Rehab) at Lake Village for nine months. When Cara came to Golden Acres, the therapy department was doing well financially and operationally in key therapy metrics; however, Cara reminded us that GOOD is the enemy of GREAT.

Cara truly is the epitome of ownership, and quickly jumped in at Golden Acres. In fact, there isn’t a function in the facility that she is not willing to take on herself or assist with as needed. She has learned how to run payer verifications for when the BOM is off; she reviews the 24-hour report and clinical documentation to identify skill in place patients; she coaches the MDs on peer-to-peer reviews for insurance authorizations, and also plays a vital role in the Keystone North market with the education and training of our other DORs.

Cara has sprinkled her expertise in the market by assisting in the training of three additional DORITOs that are now also DORs of facilities in Keystone. She has been asked to present at many therapy leader meetings, and even at the annual Ensign leadership meeting in Dallas this past year. PNSD has steadily been above $60 for well over a year (amazing!), and Golden Acres is always in the top few buildings for productivity and cost per minute. It has been truly amazing to watch Cara grow into this tremendous therapy leader and watch her partner with an amazing CEO, Rick Forscutt, and COO Karen Calma to finish out the trifecta here, and we are so thrilled to announce her new title as a Chief Therapy Officer (CTO).

Agatha Pedro, OTR, DOR, CTO, Timberwood, Livingston, TX
Agatha relocated from outside the state of Texas into a city with such charm, known as Livingston, TX, four years ago to help lead the therapy team at Timberwood. The shift from what she was familiar with could have been a tough adjustment for some, but Agatha stepped right in and embraced the city and facility with open arms.

The transition came with some growing pains such as a very limited therapy team, ever-changing department heads, and very linear therapy services that were offered. In a short amount of time, Agatha has nearly doubled her therapy team through strong partnership efforts with our Keystone Therapy Recruiter, Richard Johnson. Agatha made a conscious decision to create an interview process that was inclusive with other team members. She prides herself on her onboarding process so each new team member can be fully immersed with the Ensign experience.

There have been changes within the leadership team at Timberwood, but those changes did not impede the flow of progress. With humility and vocal confidence, Agatha supports the needs of other departments by being an actionable leader. Patient care has always remained at the forefront, as evidenced by Agatha’s competitive productivity standards that she maintains as an Occupational Therapist. She understands the operational demands of her role as Director of Rehab, but she knows that her clinical impact provides greater depth in the overall scope.

As a DOR, some may be intimidated to comfortably partner with their ED and DON … not Agatha. Agatha will initiate meetings, bring ideas, and execute tasks through strategic implementation processes. Prior to Agatha, the therapy department had very limited programs and led a very traditional process in the services that were offered. In four short years, the Timberwood facility now offers a variety of programs and therapy services that rival competitors.

Prior to the start of the pandemic, Timberwood was on track to have a strong growth in outpatient, far more than they have ever had in the past. The reputation of the therapy department created a pathway for patients to discharge and return for outpatient services. Agatha is LSVT Big certified; this is a world-recognized certification used in treating movement aspects of Parkinson’s disease. Long-term care programming has been a goal for Agatha, and she has steadfastly kept her focus there for the last two years. Through her passion for learning and intelligent risk taking, she has transformed long-term care at Timberwood.

We are half-way through 2020, and Agatha is projected to finish the year with her highest revenue performance to date. More importantly, the clinical backbone has remained solid. Therapy continually finishes with exceptional MSCA scores, and therapy has also maintained a vested interest in helping to support the quality metric performance. Agatha has only begun to tap into her potential as a therapy leader, and we are honored to recognize Agatha Pedro as Chief Therapy Officer.

 

Congratulations Carl Meyer, PT SPARC Winner!

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Carl Meyer, PT
Marquette University, Milwaukee, WI — Grad Date: 05/08/2021
In the midst of the current health crisis and social justice demonstrations, I see a world needing communities to be filled with sparks, small bright lights that the darkness cannot overcome. Indeed, as I examine my own education, talents, and abilities, I know that it is not just an opportunity, but my responsibility to step into my community as this light, and I write this encouraged, knowing that I have been equipped by those who have come before me to be that exact spark in the community I call home.

As a physical therapy student at Marquette University, my work at the local Milwaukee Rescue Mission as the Sports and Recreation Coordinator has been a foundational piece of my education. My time at the Mission has opened my eyes to the health disparities in the inner city of Milwaukee; particularly among young African-American men and in the communities they call home. The first time I drove one of my high school students to his home in north Milwaukee, I encouraged him to get his ankle examined, as he had badly sprained it that day at our Youth Center. Laughing, and shaking his head, he told me that he’d never been to the doctor before, and he wouldn’t even know where to find one. As I watched him limp to his door, the reality of Milwaukee’s environment settled in and my passion was sparked, leading me to choose a career in the medical sciences to reduce health disparities in the impoverished communities of Milwaukee.

My passion for impoverished communities and my calling to these areas of need started long before Milwaukee. Growing up in Albuquerque, New Mexico, I was a minority in the diverse and ethnic landscape of New Mexico, often witnessing the hardships of my classmates, and the health disparities experienced by Native American and underserved classmates from the reservations and poor communities of the southwest. These childhood experiences became the foundation of my mission to serve the poor by reducing health disparities, and led me to Colorado State University.

In my time at Colorado State, I was able to experience leadership as an Intern for the Office of Admissions, as an Academic Success Coordinator for the Department of Health and Exercise Science, and as a Resident Assistant. Most importantly, however, was my undergraduate thesis, which was titled “Project Play: A Mission to Study and Improve Areas of Need for Health and Wellness in Homeless and Underserved Youth Populations.” My work was written after spending a semester working with youth at the Matthew’s House, an organization that provided programming for homeless and immigrant families in northern Colorado. If my foundation was forged in New Mexico, my vision was truly carved during my time in Colorado. After graduating as a cum laude Honors student with Dean’s List distinction, and
with the Myron Ludlow Brown and Eddie Hanna Awards, my experience at the Matthew’s House led me directly to Milwaukee, and into the ZIP code with the highest rate of incarceration for men in the nation.

At the Milwaukee Rescue Mission, I provide exercise and leadership programming for homeless youth at the Mission, as well as for local students. I have frequently witnessed the impact of health education on the outcomes of the inner city youth that I work with, and this service has given me the vision of how to use my education to be a part of the outreach in Milwaukee, with an emphasis on communities with health disparities due to socio-economic divisions. I was able to start a local mentorship program for area youth at the Mission, and as my education has progressed, my vision of how to make this goal a reality beyond graduation has coalesced. I see an incredible opportunity for physical therapy to provide low-income healthcare, at clinics with high accessibility, leading to the training that can make
community mentorship a reality.

My first year at Marquette only enhanced my awareness of these disparities through my work as a Student Physical Therapist at Marquette’s Pro Bono Clinic for the uninsured. Like the Mission, I have seen the hard realities of limited access to healthcare, including one gentleman who visited our clinic after suffering from crippling pain for years and came to our clinic as a last resort. Bringing access and resources to communities that lack both has the power to drastically improve quality of life, making the reduction of health disparities not simply an opportunity, but a matter of justice. As a service-oriented University, I found further opportunity at Marquette to practice leadership by being elected Vice President of my class, and as a WPTA Emerging Leader Nominee.

Given my experiences, without the traditional corporate limitations of healthcare, I truly believe that physical therapy can reduce health disparities in a unique and practical way. My vision is to supplement my clinical practice with an initiative called The Friday Project, a project crafted during my time at the Rescue Mission. Supplementing normal clinical income with grants, those physical therapists partnered with the initiative would be able to offer community health screens every Friday, along with youth mentorship activities, including job shadowing for local students and scholarship assistance. As experts in musculoskeletal conditions among a population in which millions suffer from chronic pain, I believe we carry the education to refer high need patients, and to economically help and treat all others, bringing equity to the communities that need it most. As doctors face increased demands on their time, in which patients get less and less time, physical therapy offers the opportunity to partner healthcare with the mentorship needed to truly treat the disparities we see in the clinic.

My connections to Marquette and the communities of Milwaukee have given me the passion and platform to increase healthcare access for those who are underserved, and this is why I am applying for the SPARC scholarship from Ensign Therapy. From my experiences, my hope is that you can see my desire to use any financial assistance with the gratitude and humility worthy of such generosity. While such generosity is not intended for repayment, if I am selected, you can be sure I would pay it forward. For this reason, I believe I would make an excellent candidate for your scholarship program, as my vision and action to reduce health disparities in the Milwaukee community are already being enacted in my education as a physical therapy student at Marquette University, and as I actively live out service
in the Pro Bono Clinic and at the Milwaukee Rescue Mission.

In this way, I do not have the opportunity, but rather the responsibility to use my education to be a spark for the communities of Milwaukee. This is why I chose my profession. It gives me the chance to be a light in the community I call my own. My passion for leadership and service centers on my belief in the power of education to help those who need it most, and my learning has been supported and guided by the power of a calling found and a goal pursued. This is the legacy and strength of the many leaders who have come before me, and they continue to teach me how to translate potential into selflessness Indeed, it is the first spark that brings the light.

“If I have been able to see further, it is because I have stood on the shoulders of giants.” ~ Isaac Newton

 

Congratulations April Westbrook, OT SPARC Winner!

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April Westbrook, OT
Keiser University, Ft. Lauderdale, FL — Grad Date: 12/31/20
Fidelity is a core value of Occupational Therapy. Through trust and loyalty, this value can “spark” others toward healing. In order for patients to open up and allow a therapist to truly impact their lives, they must gather a sense of loyalty and empathy first. This value is paramount in OT and is one that I had to refine within myself prior to jumping into the field. I had to truly trust my passion, dedication, and commitment to learning before making such an immense life change.

I fell in love with Occupational Therapy when a friend of mine introduced me to the field. As I read through the qualities and qualifications of an occupational therapist, I knew that OT would provide me with a unique opportunity to make a difference in the lives of others. It was a pivotal time in my life when I made this career change; I was a mother with three young children who had just undergone a divorce from a ten-year marriage, and I was working as a small business owner where I was unable to make an impact on the lives of others the way I knew that I could. Although it was certainly not an easy time to follow this “spark,” it is one of the most rewarding decisions that I have ever made. Through this decision, I have modeled for my children that you can follow your dreams and make the necessary changes in your life at any point. Through fidelity and dedication, anything is possible.

Upon beginning my career as a COTA, schooling became my full-time job. I would care for my three children in the mornings and evenings, study until midnight, and work my part-time job on the weekends. This dedication afforded me the opportunity to serve the most endearing of people and made me stronger than I ever thought possible. I have practiced the perseverance that I encourage in others and have gained a true insight for empathy.

After working as a COTA for six years, I began to consider making another life change to provide the best possible opportunities for myself, my children, and my future patients. I began to consider becoming an OTR through a bridge over program through Keiser University. I understood that gaining more knowledge in this field would provide opportunities to make a greater impact in my community, one individual at a time. Becoming an OTR meant that I would be able to create goals for my patients that would allow them to become their most successful and independent selves. I sought the opportunity to dedicate myself to my patients through the entire OT process, from evaluation, to creating goals, bonding through treatment sessions, all the way through discharge. This wasn’t within my scope as a
COTA, and I knew that it is what I needed to do to feel fully fulfilled in my career.

The most rewarding opportunity in the field of OT is to become the agent of change in one’s life. It is incredibly humbling to connect with those who are sick or disabled and provide a means to aid in their healing and create change. When an individual looks you in the eyes and says, “thank you for understanding, encouraging me to heal, and getting me to where I am today,” it makes every sacrifice worthwhile.

I have endured many obstacles, and at times, thought the tribulations were too great to persevere through. However, those obstacles became the pivotal points to leading me into this field. I look back at these obstacles and use them as a springboard to provide the most meaningful conversations with my patients. Conversations are driven by empathy, compassion, encouragement, and a “spark” for change in the lives of others. When we fight to endure challenges, dedicate every ounce of ourselves, and then overcome these adversities, it provides a platform to help others through truly understanding by way of empathy and perseverance. Occupational Therapy provides a perfect balance between technical knowledge and compassion through our code of ethics, core values, and standards of practice, all of which come together to empower others.

I am currently working towards completing my degree as a master’s student to become an OTR. It has been a long road, especially while completing my internships in the midst of a global pandemic, but fidelity and perseverance continue to lead the way. Becoming an agent of change for individuals whose voices are not always heard and to physically improve that person’s health, is what makes Occupational Therapy the most rewarding of fields. I plan to address those needs through compassionate service, a holistic approach, creative interventions, local advocacy, and evidence-based practice. I look forward to making a lasting impact in the lives of others by creating a “spark” for healing, hope, and endless opportunities.

I appreciate any support received and am committed to paying it forward through my dedication to serving others through Occupational Therapy

Making Vital Signs Vital

MP Learn

By Tamala Sammons, M.A., CCC-SLP, Therapy Resource
We have been focused on why it is so important to measure vital signs as part of our clinical practice. Not only does the data help us with early detection of sepsis, identifying patient instability, having comparative baselines during exercise, and knowing when to stop an activity, but it also helps us make better clinical decisions around patient care. Now, therapy teams need to also focus on capturing measured vital signs into our daily documentation practices.

Measuring and documenting vital signs starts at the evaluation to ensure treatment plans are designed to address challenges with varying diagnoses and to ensure we provide interventions accordingly.

Next, vital signs are measured during treatment sessions to support decisions around interventions being provided. The key for us as therapists is to capture the data from vital signs as a guide to what interventions we will provide, or stop providing. In other words, we need to do more than simply take and record vitals. We need to use vital sign data as tools to make clinical decisions.

For example:

● Mr. Smith has O2 weaning as a goal. OT is documenting patient is SOB during activity; however, no vitals were recorded at evaluation or in TENs. Data was only entered into PCC. Here is why capturing vitals in our clinical documentation is also needed: Documentation is further enhanced when the OT documents how many liters the patient is on and levels of O2 before the activity, five minutes into the activity, and after the activity. This documentation is specific to the therapy session and needs to be recorded in the TENs as it supports what physical activity the patient can tolerate as part of decisions around O2 weaning and overall improvement with ADLs.

● Mr. Jones has precautions with BP risk identified on the PT evaluation. However, upon review of daily TENs, BP is not captured in the documentation pre-, five minutes into, and post-exercise. BP was entered into PCC, which is great for simply recording data. However, using the data in a meaningful way in our TENs supports the clinical judgment of a therapist (i.e., what decisions during treatment were made based on BP readings?) and further supports medical necessity for care.

● Mr. Romero had a CHF exacerbation and the hospital record noted he has 45% ejection fraction and he has SOB with walking greater than 75 feet. Documented vitals are paramount to ensure that his treatment with functional activities or prescribed exercise are keeping his HR between 25-35% of his target HR.

Other Examples:

● Pt. “V” has SOB and needs to rest frequently. What do the vital signs tell us and do we change direction in treatment due to those measures?

● Pt. “I” is on 2L O2. PT is working on ther ex and gait. Does O2 change with exercise? How long does it take to get them to recover?

● Pt. “T” is medically complex and post-septic. What do we know about pts who have been septic? How are we ensuring we are monitoring for s/s of sepsis while in therapy? What vitals are recorded in our documentation to support our clinical treatment decisions?

● Pt. “A” is doing breathing exercises with SLP due to COPD. What is the patient’s respiratory rate pre-, during, and post-breathing exercises? What are the O2 levels? How do we know the interventions are working?

● Pt. “L” is a cardiac patient. How are vitals documented during treatment sessions to support exercise prescription? How do we know our plan is working?

Please continue to work with your teams to not only measure vitals, but more importantly, integrate the data into evaluation and treatment documentation to support skilled intervention decisions, capture clinical judgement, and demonstrate medical necessity of our services.

 

Therapy to ED Leadership

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By Brian del Poso, OTR/L, CHC, RAC-CT, Therapy Resource
Next up in the series of interviews of our former DORs turned ED is the one and only Amy Gutierrez! She is not only a former DOR, but served as a Therapy Resource as well. Amy is currently the ED at Treasure Hills in Keystone. She was kind enough to share some of her thoughts with us:

As a DOR/Resource, you were in a good place in your career. What kinds of things were you thinking about when the thought of being an ED came up?
Jon (Anderson) was actually the one that brought it up in October of 2018 at the Leadership Summit meeting. Prior to that, I never really wanted the responsibility lol! I suppose that was when the seed was planted. Throughout that time period I considered taking my boards to becoming an Admin, I started asking questions to the other administrators. One of the most frequent questions I had was, “Is it fulfilling?” As a therapist and a resource, I know we make a difference and felt I had a purpose. I didn’t know if I would have the same sense of fulfilment as an ED. I was naïve to think that it wouldn’t be.

How did you come to the decision to push forward into the AIT/CIT program?
To be honest, I kind of jumped in. The position was offered to me at the beginning of October with the acquisition scheduled to happen in November. At that time, I was still in my Hybrid role as a DOR and Resource. I was fortunate enough to attend an AIT boot camp, which helped to solidify the decision I made in becoming an ED. As an Administrator, we are given an opportunity to change the lives of many. And where we do that as therapists and Resources, we have the opportunity to do it on a much broader stage. All of those little changes we want to make, or we wish the Admin would do, is now on us. I learned rather quickly nothing is ever as easy as it appears. We are entrusted with so much, at times it could feel overwhelming, but it’s in those moments you begin to see growth as a leader.

What do you think is the most important characteristic of a successful leader?
This is a hard question to answer. I admire so many of our own leaders but for different reasons. One of the most common traits they all have is their openness to give and receive feedback. They surround themselves with the right people. They share what they know and want every single person around them to be just as successful.

If you were to talk to a therapist about the ED role in general, what is the most important thing you would talk to them about?
Being open and honest about the things you don’t know. Ask questions, lots of them. I find myself calling my partners and resources multiple times a day. It’s OK not to have the answers. One of my mentors shared that with me early on. And it has saved me a million times over.

Any other thoughts for a therapist who might be thinking about becoming an ED?
You have to be ready for anything. I have been in my role for eight months now, and I can honestly say, I never expected to be an Administrator under the world’s current circumstances. But you do everything in your power for the people under your leadership and those entrusted to your care. Times and positions like these are what therapists are made for.

Washington Receives Eldergrow Grant

MP News

By Mira Waszak, Therapy Resource, Washington

Another gift of a grant in Washington. Pictured is Lynnwood Post Acute getting their setup and initial training.

The Eldergrow G.A.R.D.E.N Project would enable each of the nine participating Washington communities to help residents cope with this difficult time of isolation and loneliness, while also providing an interactive and meaningful activity to improve their quality of life now and long into the future.

Numerous health care studies show a positive link between gardening and healing. Contact with gardens and nature can augment a resident’s medical treatment, including mental, physical and emotional needs. Therapeutic horticulture has been proven to deliver tangible wellness benefits, including improved self-esteem, improved memory, reduced depression, improved motor skills, and increased socialization. The project goals include, but are not limited to: 1) Increasing the quality of life by improving the residents’ emotional states and 2) improving the quality of care by focusing on the six therapeutic horticulture wellness goals set forth from the American Horticultural Therapy Society. Eldergrow strives to reach an 80% resident attainment rate on both goals.

The plan to accomplish this for the nine communities will be to launch the Eldergrow G.A.R.D.E.N program as soon as possible, even if on a limited basis initially. The Eldergrow program is a well-managed, supported and respected therapeutic program offered through horticultural gardening which many residents enjoyed previously. It has been successfully used to engage residents in long-term care facilities with the best outcome of enhancing their quality of life. Eldergrow Educators use engagement and a hands-on approach, and they enable everyone in the care center — residents, staff and family, regardless of experience, physical or intellectual abilities — to participate in this program. Eldergrow enhances residents’ quality of life through therapeutic gardens physically, socially, cognitively and creatively.

Making PDPM Training Fun!

MP News

Submitted by Mira Waszak, Therapy Resource, Pennant – WA

Connecting and training with our teams has been challenging in our new normal. So how do we make training effective and fun on a Zoom call? Introducing PDPM Brain Benders by Jessika Booth, MDS Resource/Pennant WA. She created a simple but effective exercise bringing the 9 Washington IDTs together on a 30-minute Zoom call.

 

 

Jessika forwarded Reference tools the day before the Zoom meeting, which included:
PDPM quick reference guide
PDPM ST comorbidity CMI guide
NTA workbook
PDPM ICD10 Mapping
PDPM Nursing quick reference guide
And a sample diagnosis list

Zoom call format
Brain Bender Rules:
• Mute your lines unless called on or when conversation is opened to the group
• First facility to type facility name in chat answers the question
• If wrong, the second facility with name in chat will get opportunity for half of the points with correct answer
• Next question picked by facility with correct answer

Teams were only given the diagnosis sheet to answer some of the sample questions below:

Question: What PT/OT Clinical Category does the current primary diagnosis of OSTEOMYELITIS Unspecified – M86.9 map to?
Answer: Other Orthopedic

Question: Based on the diagnosis list provided, are there currently any SLP CO-MORBIDITIES available?
Answer: No, none of the diagnoses listed will map to an SLP Co-morbidity 410.

Question: Based on Diagnosis review, what would the IDT need to clarify in order to get the resident into a Special Care High Category?

Answers:
● The type of Quadriplegia — as you can only code I5100 Quadriplegia if it is a result of spinal cord injury.
● Sepsis — related to osteomyelitis and or UTI
● Respiratory Therapy — Hypoventilation Syndrome
● COPD and other restrictive lung disease — Hypoventilation Syndrome

Special thanks to Jessika Booth and our MDS partners! Congratulations to team Park Manor for winning this round of PDPM Brain Benders.

Think Thin! The Path to Thin Liquids

MP Learn

By Tamala Sammons, M.A., CCC-SLP, Therapy Resource

A new clinical campaign for our SLPs and IDT is the “Think Thin! A Path to Thin Liquids” approach. There is so much supporting evidence that promotes thin liquids over thickened liquids. When thick liquids are needed, then we need to consider utilizing the free water protocol.

 

 

 

Reasons to Think Thin:

Preventing Dehydration: Dehydration can lead to a variety of negative health consequences including:
• Changes in drug effects
• Infections
• Poor wound healing
• UTI’s
• Confusion
• Constipation
• Altered cardiac function
• Declining nutritional intake

Improving Quality of Life:
Traditional thought holds that aspiration of any material into the lungs can lead to aspiration pneumonia so many patients who have difficulty swallowing are placed on diet restrictions that avoid thin liquids.
However, a confounding evidence in the literature suggests that pulmonary aspiration of differing materials may not present an equal risk for the development of aspiration pneumonia. Aspiration will result in pneumonia only if the aspirated material is pathogenic to the lungs and the host resistance to the aspirated material is compromised. Research also discovered: “The risk of developing aspiration pneumonia was significantly greater if thick liquid or more solid consistencies were aspirated.” (Holas, DePippo, & Redding, 1994)

Being able to have Thin Water: Free Water Protocol
If a patient must be on a thickened liquid for any duration of time, research using a free water protocol found that fewer residents had UTI’s and dehydration and that when paired with proper positioning and oral care, there were no incidents of aspiration. Additionally, providing patients with thin water:
• Improves quality of life
• Improves Resident satisfaction with meals and less reports of thirst (Over 35% of patients are noncompliant with thickened liquids)
• Decreases risk of dehydration, UTI’s and pneumonia

Additional training information and materials will be coming over the next few weeks as we work to Think Thin!

CODE SEPSIS: Understanding the Sepsis Pathway and COVID

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Submitted by Tamala Sammons, M.A., CCC-SLP, Therapy Resource

The Mission:
Improve Sepsis identification early to improve patient outcomes.

The Why:
Sepsis was 20% of our Medicare Readmissions as an Organization in Calendar Year 2019.
With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%. Understanding and educating our facilities on SIRS and a focused vital-sign campaign with an SBAR-specific focus will improve our care delivery and reduce readmissions, improve our patient satisfaction, and help with our change in condition process.

COVID-19 and Sepsis: A Physician’s Lens
While there is still a lot to uncover about the pathology and presentation of COVID-19, we have learned a great deal about this virus and its potential impact in our post-acute care facilities. During our experience at one of the early COVID-19 outbreak facilities, it was discovered that an early presentation of many COVID-19 patients was the presence of a fever. Unfortunately, these fevers were managed with the typical order for acetaminophen and cooling measures, effectively masking the fever and avoiding any further escalation of care until the patient reached a point of medical instability.Sepsis POSTette

As with any patient in a post-acute care facility presenting with fever, even before COVID-19, timing is absolutely critical. Other changes of condition such as chest pain or possible stroke have led to long-standing, conditioned responses to immediately send patients out via 911. Fever is often the hallmark sign signaling the beginning of a patient experiencing sepsis — a diagnosis that carries a much higher chance of mortality, especially in the post-acute care population, but up until now has not received the attention it deserves. Oftentimes a febrile episode is masked or ignored, leading to a cascade of events leading to further demise, accelerated by a virus that now has the potential to spread like wildfire.

We are now at a point where identification of fevers (and other changes of condition) should signal a “code” event, essentially alerting the clinical team to provide immediate identification, isolation, and intervention. With every hour that a fever is ignored, the mortality rate for a potential sepsis patient increases by 8%. This simple, yet widely underappreciated clinical practice can prove to be a pivotal step in reducing the mortality in not just our COVID-19 patients, but in any patient who is on the path of developing sepsis. — Dr. Pouya Afshar

For more information, click here for our Sepsis POSTette

Therapy Update from VPAC

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By Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA
Hope everyone has been staying safe and healthy. Here is an update from the Hidden Gem of East County, Victoria Post Acute Care [Yes, that was really once a slogan of VPAC).

VPAC has continued to accept COVID + patients, and as of August 16, there had been approximately 140 COVID admissions and 95 discharges to the community (25 skilled currently). Our entire VPAC team has continued to embrace the adversity of COVID as a challenge to overcome and catalyst for learning and growth. We’ve been honored to discharge so many residents home with family members and to prior living situations. The joy on residents’ and staff’s faces when escorted out the front doors on a red carpet to waiting family members is priceless. We’re looking forward to crossing the triple digit threshold for community discharges.

Over the last few months, there have been many non-COVID-related changes within our department. Lead PT, Melissa, had a baby and has been out on maternity leave, and our wonderful SLP transitioned to a building in Texas. We’ve welcomed two new team members and are excited for their added contribution to the team. We continue to complete the LEAF form weekly for COVID-related time within the facility to have a true picture of department productivity.

Another major change within our department is the inclusion of the RNA team. The therapy team has absorbed the RNAs fully as rehab team members. The RNAs moved into the therapy gym, contribute in team meetings and participate in team building lunches/potlucks. This has allowed for greater relationship building and communication between therapists and RNAs. The increased conversation, coupled with our LTC screening process and new QM weekly meeting, have resulted in more referrals for LTC evaluations. We hope to continue developing LTC programming to better serve our VPAC residents [and increase PNSD].

We consistently find reasons to celebrate — this summer, we have had wedding celebrations, baby showers, birthday parties, goodbye and welcome parties. It’s become part of our weekly routine to have lunch together on Tuesdays. [See attached photos of celebrations].

Last month, I was invited to lead the culture portion of the resource call. We explored the Enneagram and team dynamics. I also had the opportunity to be a part of a COVID-19 Rehab Panel for the San Diego District CPTA (thank you, Sam). I was asked to share my experience and what I’ve learned from an outbreak with the facility and accepting positive patients from the community along with staying safe in the SNF setting, IDT treatment approach and mental health of COVID and SNF residents. It was a great experience exchanging information and experiences with peers.

As we persevere through the pandemic, I am often reminded how fortunate I am to have such wonderful teammates. I continue to be the proudest team leader.

Keep staying safe, wash your hands and wear a mask.