By Shelby Donahoo, M.S., OTR/L, Therapy Resource – Bandera
We all experience day-to-day (or minute-to-minute!) changes in staffing these days. Pueblo Springs in Tucson, Arizona, found themselves suddenly without a wound nurse for an indefinite time due to illness. With nursing managers working the floor, there was no one to cover this critical task.
So, DOR Josie Gorman, PT, stepped up and volunteered physical therapy to take over most of the wound care program. DNS Paulina Kareko, Josie, and ED Neil Cullen all met to discuss this as a possibility.
The team reached out to Therapy and Clinical Resources, who consulted together to determine if this was viable and considered all options, with the following questions and answers:
- Is PT qualified for this task? Yes, as verified through licensure, state practice act scope of practice, Ensign job description. Josie had also completed wound care certification training.
- How will competency be determined? With no wound care Skills Checklist in rehab, PT staff involved in wound care will complete nursing Skills Checklist, to be signed off by nursing leadership.
- What parts of the wound program will rehab take on? Dressing changes, orders, weekly rounds with MD (via telehealth at this time); nursing to continue admissions assessments, skin checks, etc.
- Can we add billable therapy wound care services to the POC? Yes, through four avenues: a) Use of Physical Agent Modalities for wound healing per Medicare guidelines for qualifying wounds (training provided); b) Adding pain management standardized assessment and goals as appropriate; c) Including functional goals in the POC pertaining to wounds: positioning, training off loading, bed mobility, therapeutic exercise to increase circulation; d) providing caregiver education and training in regard to above goals.
- What about documentation? Rehab billable tasks to remain in Optima; for non-billable tasks (weekly rounds, documentation, dressing changes), PT to document in PCC following training from nursing.
- What about cost allocation? Therapy non-billable wound care tasks to be allocated to nursing cost center.
What about the exit strategy? PT to relinquish tasks per consistent availability of nursing management and return of wound nurse; IDT discussion bi-weekly.
Hats off to the Pueblo team for thinking out of the box and working together to support patient care! Thanks to awesome Clinical Resources Sheila Summey and Julie Uychiat for collaborating to support nursing/therapy teamwork! And thanks to Pit Crew for input and suggestions.
p.s. Yesterday, a wound-care doc reported progress on a chronic ulcer that’s been plateaued for some time, with patient expressing excitement about this gain. Estim for wounds really does work, y’all, with lots of evidence to support. ☺