21 Skills for Practice in Medically Complex Environments

Background

Occupational therapy (0T) practitioners who work in hospitals, long-term acute care, and skilled nursing facilities often encounter clients with complex medical needs, such as multiple medical conditions and complex surgical histories, all of which can involve wounds, precautions, unstable vital signs, and medical lines. To help your clients achieve their goals safely, you must understand how to work in a medically complex environment. This includes understanding diagnoses and medical conditions, recognizing normal and abnormal vital signs, and monitoring medical lines. In addition, you may collaborate with an interdisciplinary team that includes doctors, nurses, nursing assistants, respiratory therapists, physical therapists, speech therapists, and occupational therapists. This section introduces the OT practitioner how to interpret vital signs and monitor telemetry machines.

Skill 1: Telemetry and Vital Signs

This video discusses how the OT practitioner can read common vital signs, monitor telemetry machines, and distinguish between normal and abnormal vital signs.

Telemetry and Vital Signs Video Transcript

Skills for Practice in Medically Complex Environments

• EKG – Electrocardiogram
  • An EKG measures the heart’s electrical activity.
• Heart Rate (HR)
  • A normal HR = 60-100 beats per minute (bpm).
• Blood Pressure (BP)
  • A normal BP = 120/80.
• Oxygen Saturation (SpO2)
  • A normal SpO2 = above 90 percent.
• Respiration Rate (RR)
  • A normal RR = 12-24 breaths per minute.

Important things to keep in mind and take-away lessons:

• Know the normal vital sign ranges and when to alert medical staff for help.

Skill 2: Medical Line Management

This video explains the different line types and how the OT practitioner can manage them during treatment sessions.

Line Management Video Transcript

Medical Line Management Tips

• IV-Intravenous Lines
  • IVs are used to deliver medication and other fluids.
  • IVs deliver medication and it is outside our practice area to administer medications.  So, do not connect or disconnect your client from an IV.
• Foley Catheters
  • Catheters are used to empty the bladder or void urine.
  • Make sure to keep the catheter bag lower than the bladder.
  • Do not disconnect the catheter or set the bag on the floor.
• Jackson Pratt (JP) Drains
  • JP drains are used to drain excess fluids from a surgical site.
  • Do not empty JP drains.
• Chest Tubes
  • Chest tubes are used to drain fluid from around the heart and lungs via a suction machine.
  • Keep the suction machine upright.
• Nasal Cannulas
  • Nasal cannulas are used to provide 6 liters per minute of oxygen through the nose.
  • Keep the cannula’s prongs facing downward in the nose.
• Simple Oxygen Masks
  • Simple oxygen masks are used to deliver 20 liters per minute of oxygen to clients in respiratory distress.
  • Work and communicate always with the nursing staff with these clients.
• Incentive Spirometers
  • Spirometers are used to assist in expanding your client’s lungs to increase their breathing depth.

Important things to keep in mind and take-away lessons:

• Work with nursing always to disconnect lines and empty drains.
• Most lines that require electricity have internal batteries, so they can be unplugged for the wall for therapy. For example, IV pumps and wound vacuums have internal batteries. Some more complex lines – such as ventilators and dialysis machines – will need to remain plugged in. When in doubt, contact nursing to confirm. Remember, if you unplugged it, plug it back in.
• Clients on supplemental oxygen will usually be connected to a building supply of oxygen or a oxygen concentrator while at rest. Portable oxygen takestanks should be available to transport the client for therapy. Remember, if you unplugged them from the wall oxygen, plug them back in.
• Consult with the medical team before disconnecting oxygen or changing the flow.

Resources

• Inpatient Acute Care OT: Surviving as a Fieldwork Student in this Complex Practice Setting, by Pamela Hess, OTD

• Occupational Therapy in the Acute Care Setting, by Sarah Stromsdorfer, OTR/L

References

• Brawley, M.D. (2019).  Appendix A: Lines, leads, and Tubes. IN Mahle, A.J. & Ward, A.L. (eds.) Adult physical conditions: Intervention strategies for occupational therapy assistants (pp. 1012-1016). FA Davis.
• Smith-Gabai, H., Holm, S.E. (2017). Occupational therapy in acute care. AOTA Press.
• Woodrow, P. (2010). Vital signs: a nurse-led education initiative for occupational therapists.
  Nursing Standard. 24, 28, 44-48.