First Day of Clinicals - Acute care! Advice?

[goyo1010]

Hey everyone! This morning will be my first venture into the acute care setting as a PT student! I'll be at a County District Hospital. Any advice? I already know to try and not drop a patient, sidestep away if the patient decides to projectile vomit or the other way out, and the like.

Thanks!

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[HHCPT]

Check the essential labs and vital signs and confirm with the nurse that it's safe to see the patient first. Make sure you have OOB orders from the doctor. Even if the patient looks healthy enough to walk, have someone spot you as needed. Be prepared. Some patients can collapse on you with no warning. A chair behind this patient will save him/her from falling to the floor.

Trust your gut. One time, doctors asked me to walk a patient and the patient was in a lot of pain. turns out, she had metastasis to the bones in bilateral legs. If I had forced her to walk with me as per the doctor's orders, I would have fractured both her legs. After I wrote a note, the doctor quickly changed his orders and kept her on bed rest until further notice.

 

[goyo1010]

Check the essential labs and vital signs and confirm with the nurse that it's safe to see the patient first. Make sure you have OOB orders from the doctor. Even if the patient looks healthy enough to walk, have someone spot you as needed. Be prepared. Some patients can collapse on you with no warning. A chair behind this patient will save him/her from falling to the floor.

Trust your gut. One time, doctors asked me to walk a patient and the patient was in a lot of pain. turns out, she had metastasis to the bones in bilateral legs. If I had forced her to walk with me as per the doctor's orders, I would have fractured both her legs. After I wrote a note, the doctor quickly changed his orders and kept her on bed rest until further notice.

Thanks a lot HHCPT! I'll keep those tips in mind as I'm seeing patients!

 

[Fiveoboy11]

Check the essential labs and vital signs and confirm with the nurse that it's safe to see the patient first. Make sure you have OOB orders from the doctor. Even if the patient looks healthy enough to walk, have someone spot you as needed. Be prepared. Some patients can collapse on you with no warning. A chair behind this patient will save him/her from falling to the floor.

Trust your gut. One time, doctors asked me to walk a patient and the patient was in a lot of pain. turns out, she had metastasis to the bones in bilateral legs. If I had forced her to walk with me as per the doctor's orders, I would have fractured both her legs. After I wrote a note, the doctor quickly changed his orders and kept her on bed rest until further notice.

I disagree with your entire first paragraph pretty much. Any PT worth anything will determine whether it is safe to see the patient. And make sure you have a doctors orders to get patient OOB before you do? How about you use clinical reasoning skills!! Speaking to the nurse regarding the patient, reading physician/nurse notes is great. Following orders is for know nothings and robots. Follow your supervising PT's "orders" and ask your supervising PT whether it is safe to get the pt OOB. Give me a break.

 

[Fiveoboy11]

Check the essential labs and vital signs and confirm with the nurse that it's safe to see the patient first. Make sure you have OOB orders from the doctor. Even if the patient looks healthy enough to walk, have someone spot you as needed. Be prepared. Some patients can collapse on you with no warning. A chair behind this patient will save him/her from falling to the floor.

Trust your gut. One time, doctors asked me to walk a patient and the patient was in a lot of pain. turns out, she had metastasis to the bones in bilateral legs. If I had forced her to walk with me as per the doctor's orders, I would have fractured both her legs. After I wrote a note, the doctor quickly changed his orders and kept her on bed rest until further notice.

HHCPT are you actually a PT? Looks to me like you're a recruiter of some kind. If so please take DPT or ODT off your profile for the love of god.

 

[GTT4DPT]

I disagree with your entire first paragraph pretty much.

Ok. I'm interested. Please explain.

Any PT worth anything will determine whether it is safe to see the patient.

Ah. Right. Like how he says you should check a person's vitals and labs before doing anything, consult with the medical team that's been overseeing the patient, and don't blindly march forward even if everyone else says it's ok...So are you saying that as a PT he is worth something?

And make sure you have a doctors orders to get patient OOB before you do? How about you use clinical reasoning skills!!

Um...because he's a PT student in an acute setting for the first time and in the process of developing those clinical reasoning skills?

Speaking to the nurse regarding the patient, reading physician/nurse notes is great.

Sounds great to me too. I'm glad we can all agree on something.

Following orders is for know nothings and robots.

Right. Like in the next paragraph where he questions an order, communicates with a doctor and helps a patient avoid a real bad time. Know nothing robot....

Follow your supervising PT's "orders" and ask your supervising PT whether it is safe to get the pt OOB. Give me a break.

Give you a break? I feel like I need a break from all these knee-jerk angry posts. It seems like the only constructive thing you're adding is: if you have a question ask your supervisor. Great. Wonderful advice. Also don't stab yourself in the face.

HHCPT are you actually a PT? Looks to me like you're a recruiter of some kind. If so please take DPT or ODT off your profile for the love of god.

Scanning HHCPT's posts, it looks like yes, he is a DPT and has been since he was 23 years old. What is the source of your vitriol? For someone who seems so energized about Physical Therapy being taken seriously as a profession, you display a shockingly low level of professionalism.

 

[jblil]

What is the source of your vitriol? For someone who seems so energized about Physical Therapy being taken seriously as a profession, you display a shockingly low level of professionalism.

Bingo. That's why I am ignoring his posts.

 

[Fiveoboy11]

Please explain? Are you even in PT school yet? You think you have any grasp on anything with regard to healthcare or physical therapy? What perspective do you have? I doubt HHCPT is actually a PT, look at his/her early posts, they are job postings, advertisements, recruiting, etc. He/she says she got a "PT doctorate" at 23 years old (relatively rare). I've never heard of anyone call it a PT doctorate.

For the record I am very energized, hard working and dedicated to physical therapy and I don't care to read lame advice from someone who is doubtful to be what they say they are.

Jblil - it doesn't look like you're ignoring my posts to me. Stop reading them, that'd be a good start for you.

 

[GTT4DPT]

Are you even in PT school yet? You think you have any grasp on anything with regard to healthcare or physical therapy? What perspective do you have?

You nailed me. I'm not in PT school yet. My only perspective is the one that I offered, which is this: You are criticizing the advice of this person (real or imagined) in a way that seems both nonsensical and angry beyond reason.

Maybe I'm way off base. If so, I hope that some people with perspective (PTs and PT students) can swoop in and liberate me from my ignorance.

 

[Fiveoboy11]

You nailed me. I'm not in PT school yet. My only perspective is the one that I offered, which is this: You are criticizing the advice of this person (real or imagined) in a way that seems both nonsensical and angry beyond reason.

Maybe I'm way off base. If so, I hope that some people with perspective (PTs and PT students) can swoop in and liberate me from my ignorance.

The advice given by HHCPT was nonsensical, my response was harsh yes, wouldn't call it angry as I was calm while writing it and am now.

PT's are not followers or orderlies. Physical therapy is physical therapy, it's not physician therapy or rehab aide therapy.

 

[RunnerGirl30]

It's required that in a hospital setting, you get OOB orders before getting a patient out of bed. It's simply marked in their chart. It's not being a follower...it's called being smart and following necessary protocols to ensure patient safety

 

[goyo1010]

The advice given by HHCPT was nonsensical, my response was harsh yes, wouldn't call it angry as I was calm while writing it and am now.

PT's are not followers or orderlies. Physical therapy is physical therapy, it's not physician therapy or rehab aide therapy.

Everyone has a point. After my first week of acute care at a county hospital where I have seen more than I have ever seen in my puny life, I can say that after getting to know how things work at the hospital and learning a lot from my CI, there needs to be a collaborative relationship.

Quite a few physicians at the hospital "order" for physical therapy (although, it's technically "consult") when there was no apparent need for PT, and my CI duly told me to use my judgment: read any previous notes, take a look at the history, go over results of any tests, and determine if there is a need for PT. Sometimes, it's the opposite, where physicians actually order PT when PT is contraindicated. In this case, my CI told me again to use my judgment on this whether or not to see the patient.

If we do have reservations about seeing a patient we can always ask for a re-consult when the pt is more stable, and that's that.

Of course, if the physician ordered strict bed rest or restrictions to activity, then obviously we can't do anything with the patient since the physician manages the pt's medical condition, and that's priority.

 

[Fiveoboy11]

Everyone has a point. After my first week of acute care at a county hospital where I have seen more than I have ever seen in my puny life, I can say that after getting to know how things work at the hospital and learning a lot from my CI, there needs to be a collaborative relationship.

Quite a few physicians at the hospital "order" for physical therapy (although, it's technically "consult") when there was no apparent need for PT, and my CI duly told me to use my judgment: read any previous notes, take a look at the history, go over results of any tests, and determine if there is a need for PT. Sometimes, it's the opposite, where physicians actually order PT when PT is contraindicated. In this case, my CI told me again to use my judgment on this whether or not to see the patient.

If we do have reservations about seeing a patient we can always ask for a re-consult when the pt is more stable, and that's that.

Of course, if the physician ordered strict bed rest or restrictions to activity, then obviously we can't do anything with the patient since the physician manages the pt's medical condition, and that's priority.

 

[Fiveoboy11]

It's required that in a hospital setting, you get OOB orders before getting a patient out of bed. It's simply marked in their chart. It's not being a follower...it's called being smart and following necessary protocols to ensure patient safety

Wrong. A PT referral is needed. Whether the patient gets out of bed during physical therapy is up to the PT.

 

[callmecrazy]

Wrong. A PT referral is needed. Whether the patient gets out of bed during physical therapy is up to the PT.

This is false from the experience I have in both acute and TCU. Each patient must be cleared by their physician for OOB, though this is often given or explicitly withheld with the PT referral. While we as PTs should utilize our clinical judgement when appropriate, we do not coordinate care in the acute setting; that is not the PTs role. That said, if you disagree with the OOB/bed rest orders, it is certainly appropriate to discuss that with the rest of the team. The team part is key.

 

[TraumaPT]

Sounds like you are in good hands with your CI, goyo1010. The acute hospital is a collaborative environment, and our job is to synthesize all of the patient's information to determine the most appropriate course of action for mobility.

With so many specialties addressing each acute hospital patient, it can be hard for the right hand to know what the left hand is doing. A good chart review is key to pulling all the parts together, coupled with respect for all of our colleagues, who may have good reasons for placing patients on bedrest.

If their reasoning lags behind current practice, that is what we call a teachable moment - a genuine and respectful sharing of information between two professionals, collaborating to achieve the greatest benefit to our patient.

 

[goyo1010]

Sounds like you are in good hands with your CI, goyo1010. The acute hospital is a collaborative environment, and our job is to synthesize all of the patient's information to determine the most appropriate course of action for mobility.

With so many specialties addressing each acute hospital patient, it can be hard for the right hand to know what the left hand is doing. A good chart review is key to pulling all the parts together, coupled with respect for all of our colleagues, who may have good reasons for placing patients on bedrest.

If their reasoning lags behind current practice, that is what we call a teachable moment - a genuine and respectful sharing of information between two professionals, collaborating to achieve the greatest benefit to our patient.

Very much agreed. Although it can take a large amount of time reading dozens of notes to try and figure out the more involved patients. Also, I guess I am fortunate to be at a teaching hospital, as the physicians seem to be more open to suggestions and recommendation, unlike some other places where there are the older physicians with the more biomedical approach. Had a PT tell us that at one hospital she worked at, she had called the physician to make a recommendation about a pt. The physician told her that it was not necessary, but the PT insisted it was best for the pt. It essentially pissed off the physician to where he said, "Are you going to write the prescription?! I didn't think so," and hung up. Not very collaborative there.