CDC publishes results of study related to injuries occuring in the bathroom resulting in emergency department (ED) visitsWednesday, July 6th, 2011

The CDC recently published the results of a study related to injuries occuring in the bathroom resulting in emergency department (ED) visits. An excerpt from the article is provided below. View the complete article at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a1.htm?s_cid=mm6022a1_e&source=govdelivery#Tab2&emc=lm&m=652713&l=14&v=2709957

PT and OT can reduce injury risk through specific analysis of bathroom mobility, environmental modifications including but not limited to non-slip surfaces, grab bars, tub seats, modified toilet seats and the use of visual contrast. Transfers onto and off of the toilet should be a particular focus of treatment for at risk clients. Addressing shower/tub safety as part of the safe transition plan is also important.  Check out the staff resources available in the ADL and falls prevention folders under clinical tools tab of the portal to help with your efforts to promote bathroom safety.

Nonfatal Bathroom Injuries Among Persons Aged ≥15 Years — US, 2008

June 10, 2011 / 60(22);729-733

In 2008, an estimated 234,094 nonfatal bathroom injuries among persons aged ≥15 years were treated in U.S. EDs, for an injury rate of 96.4 per 100,000 population. The rate for women was 121.2 per 100,000 and was 72% higher than the rate for men (70.4 per 100,000) (Table 1). Although approximately the same number of cases occurred in each 10-year age group, injury rates increased with age. Falls were the most common primary cause of injury (81.1%), and the most frequent diagnosis was contusions or abrasions (29.3%). The head or neck was the most common primary part of the body injured (31.2%). Most patients (84.9%) were treated and released from the ED; 13.7% were treated in the ED and subsequently hospitalized.

The highest rates were for injuries that occurred in or around the tub or shower (65.8 per 100,000) and injuries that happened on or near the toilet (22.5 per 100,000) (Table 2). The precipitating events in 37.3% of injuries were bathing (excluding slipping while bathing), showering, or getting out of the tub or shower; only 2.2% occurred while getting into the tub or shower. The precipitating event for 17.3% of injuries was slipping, which included slipping while bathing; 14.1% occurred when standing up from, sitting down on, or using the toilet; and 5.5% were attributed to an antecedent loss of consciousness.

Injury rates increased with age, especially those that occurred on or near the toilet, which increased from 4.1 per 100,000 among persons aged 15–24 years to 266.6 among persons aged ≥85 years. Injuries occurring in or around the tub or shower also increased markedly, from 49.7 per 100,000 among persons aged 15–24 years to 200.2 among persons aged ≥85 years. Within each 10-year age category, the relative proportion of injuries differed by location within the bathroom. The proportion of injuries in or around the tub or shower was highest among persons aged 15–24 years (84.5%) and lowest among persons aged ≥85 years (38.9%), whereas the proportion of injuries that happened on or near the toilet was lowest among persons aged 15–24 years (7.0%) and highest among persons aged ≥85 years (51.7%).

Within age categories, the relative proportion of injuries also differed by precipitating event (or activity). Among persons aged 15–24 years, the percentage of injuries that occurred while bathing or showering was 34.3% (rate 20.2 per 100,000), whereas among persons aged ≥85 years, the percentage of injuries occurring while bathing or showering was 15.5% (rate 79.9). In contrast, the proportion of injuries that occurred when getting on, off, or using the toilet was lowest among persons aged 15–24 years (2.0%) and increased with age, reaching 19.3% among persons aged 65–74 years, 26.9% among persons aged 75–84 years, and 36.9% among persons aged ≥85 years. Injury rates were 1.2, 21.6, 64.8, and 190.1 per 100,000 for age groups 15–24, 65–74, 75–84, and ≥85 years, respectively.

The injury rate associated with syncope or loss of consciousness was low. For most age groups, it accounted for fewer than 7.0% of injuries and ranged from 3.6% among persons aged 25–34 years to 9.4% among persons aged 15–24 years.

The leading injury diagnoses were contusions or abrasions (29.3%), strain or sprain (19.6%), and fracture (17.4%). The age-specific rate for contusions or abrasions increased from 13.5 per 100,000 (aged 15–24 years) to 157.9 (aged ≥85 years), whereas rates for strains and sprains increased only slightly with age. In contrast, the fracture rate increased markedly, from 5.8 per 100,000 (aged 25–34 years) to 165.6 (aged ≥85 years). Hospitalization rates, which could be calculated only for persons aged ≥55 years, followed a similar pattern (lowest among persons aged 55–64 years [11.9 per 100,000] and highest among persons aged ≥85 years [197.4]).

Reported by

Judy A. Stevens, PhD, Elizabeth N. Haas, Div of Unintentional Injury Prevention; Tadesse Haileyesus, MS, Office of Program and Statistics, National Center for Injury Prevention and Control, CDC. Corresponding contributor: Judy A. Stevens, CDC, jas2@cdc.gov, 770-488-4649.

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Assistive Technology at Our Fingertips…Wednesday, July 6th, 2011

Smart phone apps may be a useful tool as part of the individualized safe transition plan from rehab. Sample applications include voice4u–a collection of voice and picture prompts to assist clients with speech difficulties– that also allows you to download your own photos and voice prompts.  Check out the full OT practice article that includes 2 case studies and a list of applications to consider in treatment plans to address communication impairments, cognitive deficits, and ADL obstacles, including medication management. 

http://www.nxtbook.com/nxtbooks/aota/otpractice_vol16issue11/index.php#/12

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Partnering to HealTuesday, June 28th, 2011

Interested in learning more about how you can be an effective partner in facility infection control efforts? Check out the “Partnering to Heal” computer based video-simulation training program at

http://www.hhs.gov/ash/initiatives/hai/training/

to access the training tools and test your infection control knowledge by assuming the identity of a healthcare worker and making simulated decisions that impact patient outcomes and risk of transmission of MRSA, UTI and other infections. Check it out!

Please note: Content is provided for informational purposes only and is not intended as medical advice, or as a substitute for the medical advice of a physician. Individuals are urged to consult with qualified healthcare providers for diagnosis and treatment and for answers to personal healthcare questions.

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Pain Relief is a Bowl of Cherries…Tuesday, June 28th, 2011

Check out this article “Pain relief is a bowl of cherries” just published in Rehab Management:

http://www.rehabpub.com/RMN/2011-06-27_07.asp

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Professionalism in Clinical DocumentationTuesday, June 7th, 2011

Excellent therapists are no longer defined by clinical skills alone. In today’s evolving healthcare climate, clinicians must be able to reflect the skilled nature of their problem solving abilities, direct care services and measurements of postive patient outcomes with precision.  Therapy documentation may be used to determine if payment criteria are met under medical review.  But keep in mind that your entries may also be scrutinized as part of a legal dispute and analyzed during facility surveys.  The following tips will help you to meet the challenge of maintaining professional standards of documentation:

•  Consistently document objectively (what you saw, heard, smelled, felt.) If you have to document someone else’s observation, identify them as such “Restorative aide reported resident was unable to WB on LLE during transfer today.”
• The medical record is not the place to accuse or record frustrations re: lack of follow through. e.g. “nursing not applying splint as recommended by OT. This puts the facility at risk for survey problems. Instead, train staff to go through the proper channels to address issues (RD/DON) to get the best patient outcomes. We need to work with the facility to problem solve and correct breakdowns in care appropriately.     If subjective comments are made about a care problem, surveyors will expect that measures are taken to resolve that issue and the measures must be documented by the interdisciplinary team. Always maintain a professional “tone” in documentation
• Avoid statements that label a resident. Avoid comments like “confused, combative, difficult, unmotivated” as these terms do not describe what behavior is occurring. If there is reasonable expectation for progress in therapy and you are continuing services, focus on the objective factors that support continuation of services, your skilled interventions to overcome remaining deficits and areas of progress. 
• Reflect the skilled nature of your services through mention of evidence based practices utilized for the condition being treated. Describe specific treatment techniques chosen to address a particular clinical complexity. Using formalized tests and scales to show objective measures of deficits compared to normative data and to reflect progress over the rehab course demonstrates sophistication of therapy services beyond the level of non-skilled caregivers.

Source: Nursing & Therapy Documentation in Long Term Care: Skills for Collaboration and Compliance. Kate Brewer, PT, MBA, GCS, RAC-CT and Theresa Lang, RN, BSN, RAC-C, WCC

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Six Days of Suggestions to Keep the LOVE in FebruaryTuesday, February 15th, 2011

By Liz Jazwiec

I love February! Want to know why? Well, first off, it means we’ve made it through January—and thank goodness, because January is always a tough month with the end of the holidays, putting away the decorations, paying the bills, ugghh…And then of course there is the January weather! Wow, this year has been awful with the record cold temperatures and terrible winter storms. I landed in Atlanta one day and saw big piles of snow on the runways…What’s up with that? So when February 1 rolled around, I said good riddance to January; now we are in the home stretch of winter.

But that is not the only reason I love February: I also love February because as we make our way to spring, we get our shortest month…28 fast days. And to top it all off, smack dab in the middle of those 28 days is Valentine’s Day, the day devoted to love. How magnificent!

I am urging all of you to really celebrate the holiday of love this year, and to use it as the perfect catalyst to chase out any negativity that crept back in during January after the fun of the holiday season or even stuck with you during the first part of February. When I was working at Holy Cross Hospital, we celebrated Valentine’s Day for an entire week, and when you do that, you can’t help but chase away the winter blahs and the negativity that goes with it.

So here are six days’ worth of suggestions to choose from: 

1. Coworkers. Remember how fun it was to get those cute valentines in those little envelopes at school? Guess what: It still is! Can you imagine looking in your mailbox at work and finding ten tiny cards? Encourage your colleagues to pick out valentines that best suit them, like Bob the Builder from the person who’s always remodeling their home, or Snoopy from a pet lover, or Strawberry Shortcake from a petite team member.
2. Customers. These can be patients or internal customers. For patients, you could give red pens with pink hearts on them along with the hospital’s or department’s name. You also could have something printed on the pens such as, “We love our imaging patients.” Internal departments could do something sweet for their customers: IS/IT Departments could spend time out on the units cleaning keyboards, and Marketing Departments could coordinate a poster contest for support departments to acknowledge the internal departments that they serve. The posters could be displayed and voted on in the cafeteria.
3. Colleagues. How about those folks in other departments who make your life easier? For example, simple cards signed by everyone in your department given to the cafeteria folks who always wait that extra minute when you are running late to catch the last serving time, or to the housekeepers who know what your floor needs even before you page them are sure to be appreciated.
4. Physicians. We know that Doctor’s Day is in March, but how about a little preview? You could do baskets of those conversation hearts or Hershey’s kisses in the physicians’ lounge or at the doctors’ entrance if you have a separate one. An amusing heart-shaped sign above each basket (I mean, you want them to know where the treats came from!) could read, “At ABC Medical Center, we love our physicians,” or, “Memorial physicians are really sweet”…Okay, maybe that’s a little too much, but you get the idea.
5. Families and visitors. Imagine how great it would be if one day during Valentine’s week, visitors were surprised with free coffee and heart-shaped cookies. The treats don’t have to be extravagant or costly—just a cart with some decorations and perhaps a placard that reads, “We love our families and friends.”
6. Staff. If you are a leader, now is the perfect time to let your team know how much you appreciate them. My all-time favorite, which also became a tradition, were heart-shaped pink bagels…Yep, I said pink bagels. A local bagel place did them every year, and of course they were served with strawberry cream cheese. Baskets of candy also work, as does sending flowers because they last for several days (meaning several shifts).

I promise you, with all this love and celebration going on for a week, it will chase negativity right out of the place. The next thing you know, it will be February 21…Then, poof, only one more week ’til the end of the month. And we all know what that means: March and, hallelujah, SPRING!

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What are Organizational Core Values?Monday, September 20th, 2010

The core values of an organization are those values we hold which form the foundation on which we perform work and conduct ourselves. In an ever-changing world, core values are constant. Core values are not descriptions of the work we do or the strategies we employ to accomplish our mission; instead, these values underlie our work, how we interact with each other, and the strategies we employ to fulfill our mission. Core values are the basic elements of how we go about our work. They are the practices we strive to use every day in everything we do.

HTS Core Values:

Innovation: Innovation is defined as a change in the thought process for doing something; the useful application of new inventions or discoveries. At HTS, we believe our business and clinical practice thrives when we are adaptable, open to new ideas and foster creativity.

Community: Relationships with co-workers and customers built on respect, empathy, and integrity are key to positive outcomes for all of us.

Hope: Through effective rehabilitation service, we offer the hope of recovery and a plan for the future based on the foundation of clinical expertise and realistic goal setting for each individual in our care.

Stewardship: Responsible management of resources-time, talent and treasure, through careful planning, cooperation, responsiveness and accountability secures our present and future success.

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