Interdisciplinary Care PO 007

Learning Objectives The physical therapist technician will learn how to interact with other health care professionals by: Defining Interdisciplinary care Identifying the various members of the multidisciplinary team Describe the roles of the team members Define medical rounds and PT role in rounds Understand when to consult with other health care professionals about patient care

Learning Objectives Continued . . . Understand when mandatory reports to other health care professionals on patient status are required Understand the difference between medical and administrative issues, and which team members are responsible for each Define community partners and identify those that apply to physical therapy Be able to access help from community partners when required

Interdisciplinary One or more disciplines working collaboratively Members of several professions providing interventions independently, but also collaborating with each other to ensure optimal outcomes This approach involves professionals operating within the boundaries of their profession towards discipline-specific goals, while recognizing the important contribution from other disciplines

Interdisciplinary Teams An interdisciplinary team is a group of practitioners from different professional backgrounds who work together to achieve jointly established goals for patients/clients Interdisciplinary teams provide interprofessional collaborative practice: The interaction of two or more health practitioners from different professional backgrounds to deliver the highest quality of services to patients/clients

Members of the Team The members of an interdisciplinary team vary but can include: The patient Doctor Nurse/nursing assistant PTT Pharmacist/pharmacy technician Physician assistant Dentist/dental technician Mental health professionals Bmet Medical logistics Family members/care givers

An Effective Team Essential elements for effective teams: Shared goals: reasons to work together Interdependence: recognition of individual roles in the achievement mutual goals Commitment: working together leads to more effective decisions Accountability: shared commitment as a functioning unit

PTTs and Interdisciplinary Teams When PTTs are members of a interprofessional team providing services for the patient/client, they will ensure that: Relevant information is sought and communicated promptly and clearly within the team A system is in place for written communication with other members of the team the physical therapy goals comply with the team goals

PTTs and Interdisciplinary Teams Continued . . . Policies exist for referral to other professionals, discharge, and transfer of patients/clients Team members participate in case conferences, rounds, individual patient/client care meetings, discharge planning, and the preparation of collaborative patient/client records

Medical Rounds The medical problems and treatment of a particular patient are presented to an audience consisting of doctors, residents and other health care professionals Are an important teaching tool and ritual of medical education and patient care Allow healthcare professionals keep up to date in important evolving areas which may be outside of their core practice

Medical Rounds Continued . . . Currently, medical rounds take place in NMH on a weekly basis and are mainly attended by doctors and nurses It would be beneficial for PTTs to become involved in rounds as they are members of the interdisciplinary team, and could benefit from the information and education provided This is something for future PTTs to establish as part of promoting the role of physical therapy in interdisciplinary patient care

Consulting With Team Members It is important for the provision of care that each discipline not work independently, but always recognize the team approach to patient care Regular consultation with appropriate health care professionals is essential In order to consult properly with other health care professionals, it is important to understand each professions role

Collaboration The PTT collaborates with other professionals as appropriate The PTT shall be aware of the qualifications and roles of other professionals involved in comprehensive patient/client care/management, and practice in collaboration with them to provide quality services

Collaboration Continued . . . PTT collaboration when appropriate: Uses a team approach to the management of patients/clients Provides instruction to patients/clients and families Ensures professional development and continuing education

Defining Roles Although the responsibility for various aspects of patient care are not always clearly defined, and there is overlap, the following can be used as general guidelines: Doctors: Usually lead patient care and coordination Provide diagnosis and outline the treatment plan Nurse/nursing assistants: Responsible mainly for implementation of inpatient care by facilitating treatment plans and liaising with all team members

Defining Roles Continued . . . Pharmacist/pharmacist techs: Pharmaceutical counseling and management Physician assistants: May be involved, especially in more regional locations where there may not be a physician Dentist/Dental techs: May be involved if the patient has facial or dental injuries or conditions Social worker/mental health: Responsible for mental health conditions Often works with the family in facilitating support for the patient when they return home

Defining Roles Continued . . . Bmet: Responsible for the maintenance and repair of health care equipment Medical logistics: Responsible for provision of supplies needed for patient care Family members/care givers: Act as support network for patient The patient

When To Consult? It is absolutely necessary to consult with the team lead (usually the doctor) when: There is a decline in patient status There are contraindications to treatment outlined in the referral or treatment plan The patient presents with new signs or symptoms that are not related to the condition for which they were referred to PT The patient has had a new injury

Why To Consult Continued . . . Other reason PTTs may consult with various health care professionals: There is a concern with the patient or their care that is out of the scope of the PTT The patient requires treatment from another provider that will impact the PT treatment The PTT has a concern about an issue that is out of their scope, but has an impact on PT treatment The patient expresses concerns about treatment received from another provider There are administrative issues with patient care

Clinical vs. Administrative When consulting with the interdisciplinary team, it is important to understand the difference between clinical and administrative issues: Clinical: Deals with the direct care required or provided eg. pain levels, weight-bearing status, infections, etc. Administrative: Deals with the organization, policy, procedures, resources, etc., of the care provided eg. patient scheduling, payment and insurance, equipment concerns, employment and chain of command issues

Clinical vs. Administrative Continued . . . It is important that when consulting with members of the interdisciplinary team that the right person is consulted about the right issues Clinical matters are to be address by clinicians i.e. doctors, nurses, senior PTTs, etc. Administrative matters are to be addressed by administrators i.e. chain of command, med log, Bmet, etc.

Community Partners An entity, person or organization that serves the interests of similar clients Connections between and among people and groups to share interests and concerns, and create visions for the future Often governmental or international provision of assistive services to people in need

Community Based Rehabilitation (CBR) A community development strategy for the rehabilitation, equalization of opportunities, and social integration of all people with disabilities Implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services

CBR Continued . . . The use of CBR is essential in Afghanistan and in the ANA, as the health care system is still evolving and is not yet self-sufficient There are several community partners that are crucial to the provision of PT services Relationships should be established with the appropriate community partners to ensure the best possible PT care is provided to patients

PT Community Partners The following are useful community partners for PTTs in the ANA: Physiotherapy Training Institute of Kabul (PTI) http://www.iam-afghanistan.org/what-we-do/health-care/physiotherapy-institute/physiotherapy-training-institute International Committee of the Red Cross (ICRC) http://www.icrc.org/eng/ World Confederation of Physical Therapy (WCPT) http://www.wcpt.org/ The World Health Organization (WHO) http://www.who.int/en/

Engaging Community Partners It is important that PTTs use community partners appropriately The PT chain of command should be notified when community partners are required, and should continue to be informed about their involvement Since there is currently no PT regulatory body in Afghanistan, reliance on international PT organizations is essential to guide PT care, standards and guidelines

Summary Interdisciplinary care requires all health care professionals to work together to reach common goals The patient should be at the center of all care Team members must work within their respective scopes of practice and seek guidance from other professionals when required Community partners should be utilized to ensure the best PT care is available

Questions?

Comprehension Check What constitutes an interdisciplinary team? Under what circumstances is it absolutely necessary for a PTT to contact the physician/ interdisciplinary team leader about a patient? Under what other circumstances should a PTT consider consulting another health care professional? How do clinical and administrative issues differ? What is Community Based Rehabilitation (CBR)?

Answers A group of practitioners from different professional backgrounds who work together to achieve jointly established goals for patients/clients When: There is a decline in patient status There are contraindications to treatment outlined in the referral or treatment plan The patient presents with new signs or symptoms that are not related to the condition for which they were referred to PT The patient has had a new injury

Answers When: There is a concern with the patient or their care that is out of the scope of the PTT The patient requires treatment from another provider that will impact the PT treatment The PTT has a concern about an issue that is out of their scope, but has an impact on PT treatment The patient expresses concerns about treatment received from another provider There are administrative issues with patient care

Answers 4. Clinical: Administrative: Deals with direct patient care required or provided Administrative: Deals with the organization, policy, procedures, resources, etc., of the care provided 5. A community development strategy for the rehabilitation, equalization of opportunities, and social integration of all people with disabilities