Documenting Activities

Question 1

Patient-Specific Orders

Answer 1

• Restrictions/Precautions
• Weight bearing status
• Activity Orders

Gather these in the medical chart review; If you don’t know and don’t have access ask the patient for information then ask their physician.

Question 2

Restrictions

Answer 2

• Setting dependent restrictions
  – Visitors (Number limit or covid)
  – Monitoring devices (Don’t detach unless allowed)
• Post-surgical restrictions
  – Related to drains/tubes
  – Positioning (THA)

Question 3

Infectious Disease Precautions

Answer 3

Require additional PPE and treatment setting considerations:
– Contact
– Droplet
– Airborne

With precaution may not be able to go to specific places in a hospital.

Question 4

Contact precaution

Answer 4

patient has a condition that is transmitted by direct contact with a person or items in their environment (C-Diff, draining wounds)

Question 5

Droplet precautions

Answer 5

patient has a condition transmitted by large particle droplets of sputum or mucus (strep throat, whooping cough, flu)

Question 6

Aireborne precautions

Answer 6

patient has a conditiontransmttedthrough the air (TB, COVID, SARS)

Question 7

Weight Bearing Restrictions

Answer 7

• variation in interpretation of Lower Extremity and sometimes upper extremity
• based on patients BW that should be transmitted through limb
• Cannot use documentation to describe gait

Question 8

Non-weight Bearing (NWBing)

Answer 8

• Foot does not touch the ground
• Upper extremity cannot be used for support

Question 9

Toe-touch Weight Bearing (TTWBing)

Answer 9

Foot contacts ground for balance only
Only up to 20% of body weight

Question 10

Partial Weight Bearing (PWBing)

Answer 10

Designated as 20-50% of body weight

Question 11

Weight Bearing As Tolerated (WBAT)

Answer 11

Limited ONLY by patient tolerance (usually 50-100%)

Question 12

Full Weight Bearing (FWBing)

Answer 12

No restriction / 100% WBing

Question 13

Give an example of Weight Bearing

Answer 13

NO “patient is WBAT, when walking, demonstratesTTWBing”

YES “orders for WBAT on B LEs; noted when patient was participating in transfers / ambulating, put decreased weight through R LE during stance; patient indicates this is due to increased R knee pain to 7/10 in stance”

Question 14

Activity Orders and Progressions

Answer 14

• Bedrest (strict – not out of bed for any reason)
• Bedrest with Bathroom Privileges / Commode Privileges
• Dangle at Edge of Bed (may be specific with durations)
• Up to Chair (may be specific with durations)
• Activity as Tolerated (no restrictions, but must be supervised / may require assistance for mobility)
• Up Ad Lib (no restrictions, can walk freely about the room and unit)

Question 15

Elements of Documentation

Answer 15

• Clear and defensible
• Needs to reflect all relevant aspects of the patient encounter in a way that can be understood by all members involved in the patient’s care and can be reproduced by other professionals
• Needs to be timely (Same day)

Question 16

Functional Mobility Tasks

Answer 16

• Bed mobility
  – Rolling
  – Shifting
  – Re-positioning
  – Supine to/from sitting
• Transfers
  – Sit to/from stand
  – Lateral transfers (pivot, slide board, lift)
• Ambulation
• Stair navigation
• Wheelchair mobility

Assistance, guidance, help are reasons for skilled PT. All examples above.

Question 17

Ambulation and Distance

Answer 17

• Ambulation <50 feet (between a few rooms in a home with rest between trips)
• Ambulation 50-150 feet (full household ambulator)
• Ambulation > 150 feet (community ambulator)

Always document how far they went.

Question 18

Assistive Devices Utilized

Answer 18

• Bed Mobility
  – Rails, Trapeze
• Transfers
  – Lift, gait device, rails, slideboard
• Ambulation
  – BW Support, Gait device
• Stairs
  – Railings, side of rail
• Slings/Orthoses

Question 19

Levels of Physical Assistance

Answer 19

• Independent
• Supervision
• Standby Assist/ SBA
• Contact Guard Assist/ CGA
• Minimal Assist/minA
• Moderate Assist/ModA
• Maximum Assist/maxA
• Dependent

How much assistance the patient requires to successfully and safely complete the task
Specific cues (manual or verbal)
May require more than 1 person

Question 20

Independent

Answer 20

No manual assist, supervision, or cues (can use device)

Question 21

Supervision

Answer 21

Not directly next to patient, observes task, ready to provide cues

Question 22

Standby Assist/ SBA

Answer 22

• Ready to provide manual assist, but close
• No hands on

Question 23

Contact Guard Assist/CGA

Answer 23

1 or 2 hands in contact, with or without cues, balance support

Question 24

Minimal Assist/minA

Answer 24

Provider does 25% of work / patient does 75% of work

Question 25

Moderate Assist/modA

Answer 25

Provider does 50% of work / patient does 50% of work

Question 26

Maximum Assist/maxA

Answer 26

Provider does 75% of work / patient does 25% of work

Question 27

Dependent

Answer 27

Provider does 100% of work / lift dependent

Question 28

Other Considerations for Documentation

Answer 28

- What are the limiting factors in participation? -- Pain? --- Ratings --- Location -- Fatigue? - Did they need extra time? -- Why? * How many repetitions were they able to complete? * Do they perform consistently? * How far were they able to ambulate or propel the wheelchair? * Can they perform in a variety of environmental conditions? ## Footnote Make sure it is measureable, give values

Question 29

Plan of Care - Goals

Answer 29

* A (actor) – who will accomplish goal? * B (behavior) – what is expected task / activity? * C (conditions) – with what devices? With what level of assist?  * D (degree) – consistency? Frequency? What environment / context? Efficiency? * E (expected time) – setting specific

Question 30

Identify the missing components of the goals below: 1. Patient will complete transfers independently.  2. Bed mobility with railings in 2 weeks. 3. Patient will demonstrate improved right knee flexion to 80 degrees in 2 days.  4. Patient will complete sit to/from stand and pivot transfers using 2ww and minA x 1 for guidance of R LE by 3/2/21. 

Answer 30

1. Patient will complete transfers independently. (Time, Type of transfer, environment/context) 2. Bed mobility with railings in 2 weeks. (Type of mobility, patient, any assistance?) 3. Patient will demonstrate improved right knee flexion to 80 degrees in 2 days. (assistance?, need to tie a function to their condition/context) 4. Patient will complete sit to/from stand and pivot transfers using 2ww and minA x 1 for guidance of R LE by 3/2/21.  (too many tasks)

Question 31

Examples of Well Written Mobility/Activity Goals: Pt. will complete bed mobility & transitions with minA x 1 to manage R LE prior to discharge to home setting. Pt. will complete sit to/from stand and pivot transfers with 2ww & modA x 1 for boost / lower prior to discharge to SNF. Pt. will ambulate up/down 4 steps using single railing and CGA x 1 for safety prior to discharge to home setting.  

Answer 31

Cannot discharge a patient ONLY physicians