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Understanding Interdisciplinary Assessments in Recreational Therapy

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ursula-dean
17 diapositives · 397 Views · Nov 17, 2014

As healthcare documentation systems shift to computerized formats, recreational therapists must engage with interdisciplinary assessments within their scope of practice to ensure accurate outcome calculations. This evolution in documentation represents a significant change; if data isn’t entered into computerized systems, it is effectively considered non-existent. We must familiarize ourselves with instruments such as the RAI/MDS and FIM to maintain our role in interdisciplinary care. This presentation will cover the essentials of these assessments and their impact on patient care and treatment planning.

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Understanding Interdisciplinary Assessments in Recreational Therapy
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  1. Interdisciplinary Assessments KNR 279

  2. burlingame email • All of health care is computerizing its documentation systems which has allowed the calculations of outcomes on a system wide (national) basis. If recreational therapists do not start filling out the interdisciplinary assessments for the areas that are within our scope of practice, you are right, we will die a slow and painful death. However, there are many parts of these computerized interdisciplinary tools that are within our standard scope of practice. We used to say if it wasn’t written, it didn’t happen. Now, if it was not entered into these few interdisciplinary documents, it did not happen, even if we write it down in the electronic or paper charts.

  3. Interdisciplinary Assessments • WHO – ICF (Next) • RAI/MDS (Nursing homes, today) • IRF-PAI (Rehab facilities, today) • FIM • Still need specific discipline assessments

  4. RAI/MDS • Resident Assessment Instrument (RAI) • Minimum Data Set (MDS Version 2.0) • Interdisciplinary assessment & care planning process • Used in long term care • Standardized • Computerized • National data base

  5. RAI/MDS (cont.) • 1987 Omnibus Budget Reconciliation Act (OBRA) • First implemented in 1990 • Computerized in mid 1990’s • VA required use in NH units in 2001 • See MDS handout • Identifies: Needs, strengths, preferences, description of functional skills, directs content of care plan, identifies need for further assessment

  6. RAI/MDS (cont.) • RT Section N • Also may be • AC: Customary routines • B: Cognitive patterns • C: Communication/hearing patterns • E: Mood & behavior patterns • F: Psychosocial well-being

  7. RAI/MDS (cont.) • Section T: Supplemental Case Mix Demo • T1a: Recreation Therapy • Must be active treatment • Physician’s order • Provided by CTRS • Beyond activity program

  8. RAI/MDS (cont.) • MDS completed • Sources: resident record, observation/interview, direct care staff, professionals, family • Triggers • Scores that indicate need for further or in depth assessment • Resident Assessment Protocols (RAP) • More detailed assessment process • Comes from triggers • 18 areas

  9. RAI/MDS (cont.) • Quality Indicator (QI) • Potential problems related to health care services or quality of life • Identified through MDS • Additional treatment objectives based on QI data • Treatment plan based on • RAI (MDS + RAP) • QI

  10. RAI/MDS (cont.) • Resource Utilization Guidelines • (RUGS III) • Summary of scores & places in 1 of 7 tx groups or categories • 1 Rehabilitation • 2 Extensive services • 3 Special care • 4 Clinically complex • 5 Impaired cognition • 6 Behavior problem • 7 Reduced physical function

  11. RAI/MDS (cont.) • Perspective Payment System (PPS) • Not actual cost of care • Average cost for all residents in same RUGS III category • Based on particular part of country • Payment based on how MDS filled out

  12. FIM • Functional Independence Measure • Used in rehabilitation • Basic indicator of severity of disability • Can be administered quickly • Can be administered to groups • Discipline free

  13. FIM (cont.) • 7 level scale • Dependence to independence • Ability to carry out activities independently • What usually does not what could do or what performed once • If difference in environments, use lowest score • Do not leave any area blank

  14. Eating Grooming Bathing Dressing Toileting Bladder Mgmt Bowel Mgmt Transfers Locomotion Comprehension Expression Social Interaction Problem Solving See Handout FIM Areas

  15. Alexian Brothers • FIM (Social Interaction) • RICFAS (Rehabilitation Institute of Chicago Functional Assessment Scale) • Domain: Community Integration • Recreation Resource Awareness • Leisure Skills • Community Recreation Reintegration

  16. IRF-PAI • Inpatient Rehabilitation Facilities Patient Assessment Instrument • New (1/2002) • Similar to long term care • Using FIM in clinical section • Assessment & reimbursement rate

  17. IRF-PAI • TR typically looks at • Locomotion • Communication • Social cognition • Motor & cognitive skills in naturalistic setting (community reintegration outing) • No leisure • Often use LCM