Interdisciplinary Care PO 007

1. Interdisciplinary CarePO 007

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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

23. 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

24. 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

25. 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/

26. 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

27. 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

28. Questions?

29. 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)?

30. 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

31. 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

32. Answers 4. Clinical: • 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