Formulation and Implementation

1. Formulation and Implementation Donald E. Katz, C.O., L.O. Kevin Felton, C.O., L.O.

2. TSRHC Orthotic Residency Program • 7:1 CO/CPO to Resident • Closed ended 12 month • Orthopedic children’s hospital • No charge for services • Treat employees and family members • Multiple education opportunities • POC, O&P monthly, Brandon Carroll, Dallas Short Course

3. Our Philosophy • Resident is responsible for patient care • CO is responsible to assure that the resident provides appropriate care • Drop-in policy assures that patients change practitioners - numerous opportunities to accept responsibility of care.

4. Self-Paced • CO in the exam room until comfort level reached • CO checks work throughout the year • Patient load increases and fabrication decreases

5. Self Paced • Filling casts • Pulling plastic, trimming out orthoses • Delegating orthoses to technicians • Bending metal

6. Self Fabrication“Until Competent” • Numerous AFO’s; One of each new system • Technical supervisor inspects work

7. Understanding of processes Knowledge of material properties Pride in workmanship Communication skills Team work Documentation Self Fabricationvs. Delegation

8. Quarter System • 1st Below Knee • AFO, SMO, UCBL, FO • 2nd Above Knee • KAFO, HKAFO, RGO • 3rd Scoliosis • 4th Everything

9. Drop Ins (Clinic Referrals) • Evaluate orthoses made by others • See what works • See what doesn’t work • Provision of “follow-up” care

10. Clinic Attendance • Spina Bifida and Scoliosis • Familiarity with the clinic team • Evaluation of orthoses made by others

11. Standards of Practice • Compilation of treatment philosophies • Clinical decision making (Rx considerations) • Technical decision making (when to use what; trimlines, etc.) • LE orthoses • Boston Braces

12. Standards of Practice • Written reference • Provide some uniformity • Additional learning modality • Require input when revising these documents

13. Patient Education Handout

14. Patient Education Handouts • Provide consistent instruction • Ease documentation • Provide talking points • Leave room for patient specifics

15. Measurement Form

16. Functions of Measurement Form • Forces resident to think about design • Ankle joint type • Plastic type and thickness • Wedges or posts • Medial or lateral flange • Extended forefoot walls • Acts as a work order

17. Documentation • Formats • Check off boxes • “Wall of Shame” • Countersignature

18. Dictation Formats • Paired Formats: • “Initiation of Orthotic Treatment” • “Initial Orthotic Fitting” • Narrative Formats

19. Casting Visit: Demographics Orthotic History Physical Evaluation Treatment Goals Questions / Concerns Plan Delivery Visit: Goals met? Skin Integrity Special Modifications Patient Education Special Instructions Plan Paired Dictation Formats

20. Preparatory care • Aquaplast AFO splints • clubfoot

21. Formulation of Treatment Plan • Tx goals and expected outcomes • Consult with Dr./referral source • Identify material, design, and components • Develop a plan for patient needs • Document treatment plan • Inform Px, etc. of financial responsibilities

22. Inform Px Select materials/techniques Provide preparatory care Prepare Px Implement procedure (e.g. cast) Select materials Consult technical component/material resources Prepare for fabrication Modify Fabricate Assess device Assess / align Ensure ... fit/delivered Complete fabrication Educate Reassess Document Implementation of Tx Plan

23. The Tough Stuff • Observational gait analysis • “Orthotic Eye” • Communication • Working efficiently

24. Teaching Methods • Ask open ended questions • Don’t give the answers • Repetition

25. Thank You